
Glass 

Book ■ H $ Jl 



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HOW TO GET WELL, KEEP WELL, AND LIVE LONG. 



THE 



EVERY-DAY DOCTOR. 



A HOUSEHOLD BOOK OF PRACTICAL MEDICINE, CONTAINING 

A FULL ACCOUNT OF THE DISEASES OF THE HUMAN 

SYSTEM, WITH APPROPRIATE REMEDIES AND 

A COLLECTION OF VALUABLE RECEIPTS. 



BY 

GEORGE H. HOSMER, M. D. 



NEW YORK: 
D. APPLETON AND COMPANY, 

549 & 551 BROADWAY. 
1876. 






Entered, according to Act of Congress, in the year 1876, by 
D. APPLETON & COMPANY, 
In the Office of the Librarian of Congress, at Washington. 



PREFACE 



In Spencer's Treatise on Education it is held that all should 
endeavor to acquire that kind of knowledge which is of the 
highest practical value ; and the philosopher, in considering what 
men and women should study, naturally gives the first place to 
those parts of knowledge whose primary objects are to keep men 
alive, and in such a state of physical and mental efficiency as fits 
them for a proper discharge of their duties to their families and 
to society. It is of little use that we acquire accomplishments 
fitting us to shine in the world, if our sphere is to be an invalid's 
room ; and there is small advantage in the knowledge of the 
ways even in which men make money, if ignorance of the con- 
ditions of our own life induces disease that makes it impossible 
to enjoy the wealth we may secure. 

How to keep alive, therefore, and how to shun or combat the 
commoner perils that threaten health, are the first things that 
every one should be taught ; and we present an outline of this 
knowledge, in the full appreciation of its importance. 

Physiology, for some time an exclusive science, is becoming 
a popular possession, and a knowledge of necessary hygienic 
rules flows from its principles ; but it has always been doubted, 
by physicians chiefly, whether the science of medicine proper 
should ever be presented in a popular form. The true answer 



IV PREFACE. 

to this lies in the consideration of the evil of quackery. Upon 
what does quackery thrive ? Ignorance — and ignorance of things 
that all might readily learn. And they who object to instruct- 
ing the people in medicine, knowing all the time the full propor- 
tions of the harm done by quackery, would perpetuate the condi- 
tions that give that evil life. 

" The writer of a good practical book on medicine," says La- 
tham, "who tells the world something that it did not know 
before, something of large application in fortifying or restoring 
the health, strength, and comfort, of man's body and mind ; or 
who, if he tell nothing new, yet wisely sets in order what is 
already known, and gives it a more convenient adaptation to the 
same high purpose ; such a writer, in all just estimate of things, 
is second, and second only, to the great expounders of moral and 
religious truth." 



CONTENTS. 



PAGE 

Summary of Physiology: 

Digestion 1 

Absorption 4 

Circulation of the Blood 5 

Respiration. 9 

Assimilation and Secretion 11 

Excretion 12 

Functions of the Nervous System . 13 

Special Senses 16 

The Eye 16 

The Ear 18 

Smell Taste, and Touch 20 

The Sympathetic System 21 

Anatomical Description of Impor- 
tant Organs: 

Abdomen 22 

Stomach 23 

(Esophagus 25 

Intestine 25 

The Liver 26 

Gall-bladder 27 

Kidneys 27 

Bladder 27 

Thorax 28 

The Heart 28 

Lungs 30 

Arteries 32 

Veins 33 

Brain 34 

Bone 35 

Spine 36 

Muscles 37 



PAGE 

Pelvis 39 

The Throat 40 

Hygiene and Diet : 

The Air 41 

Food 44 

Condiments 48 

Drinks 49 

Exercise 52 

Use of Water 53 

Sleep 55 

Indications and Distinctions of 
Disease : 

Pain 57 

The Pulse 58 

The Tongue 60 

The Countenance 61 

The Lips 61 

The Gums 62 

Expectoration 62 

Screaming 63 

Table of Symptoms 63 

Diseases of the General System: 

Fever in general 66 

Distinctions in Continued Fever. . 67 

Typhus and Typhoid Fever 67 

Particular Distinctions between Ty- 
phoid and Typhus Fevers 70 

Simple Fever — its Special Features 

and Treatment 73 

Gastric Symptoms 74 

Intermittent Fever 75 

■Remittent Fever 78 



VI 



CONTENTS. 



PAGE 

Yellow Fever 80 

Influenza or Grip 82 

Small-pox 83 

Vaccination 86 

Scarlet Fever 87 

Measles 90 

Chicken-Pox 91 

Erysipelas 92 

Hectic Fever 94 

Scurvy 95 

Cholera 95 

Cancer 97 

Scrofula 99 

Inflammation 100 

Rheumatism 103 

Chronic Rheumatism 105 

Gout 107 

Syphilis 112 

Tuberculosis 117 

Diphtheria 118 

Diseases op the Chest and Respi- 
katopvY Organs : 

Catarrh 120 

Inflammation of Larynx 121 

Chronic Laryngitis 121 

(Edema Glottidis 122 

Croup , 122 

Inflammation of the Lungs 123 

Pleurisy 125 

Bronchitis . 126 

Whooping-cough 127 

Asthma 128 

Sore-throat 131 

Consumption 132 

Diseases op Digestive Organs: 

Inflammation of the Mouth 136 

Canker Sore-mouth 136 

Inflammation of the Stomach 137 

Indigestion, or Dyspepsia 138 

Gastralgia — Cardialgia — Coeliac 

Neuralgia 141 

Gastric Ulcer 142 

Cancer of the Stomach 143 

Vomiting Blood 143 

Congestion and Inflammation of 

the Liver 144 

Cirrhosis 146 

Biliary Derangements 146 

Jaundice 147 



PAGE 

Gall-stones 148 

Inflammation of the Bowels and 

Peritonaeum 148 

Diarrhoea 149 

Chronic Diarrhoea 151 

Dysentery — Bloody Flux 152 

Colic 153 

Worms 154 

Costiveness 156 

Piles 157 

Descent of the Rectum 159 

Rupture 159 

Fistula . ... 161 

Diseases op the Urinary and Gen- 
ital Organs: 

Inflammation of the Kidneys 162 

Diabetes 163 

Bright's Disease 164 

Renal Colic 165 

Inflammation of the Bladder 165 

Irritable Bladder 167 

Incontinence of Urine 168 

Stone in the Bladder 169 

Gravel 170 

Inflammation of Urethra — Gon- 
orrhoea — Clap 172 

Gleet 174 

Stricture, or Retention of Urine ... 175 
Spermatorrhoea — Involuntary or 
Nocturnal Emissions — Impo- 
tence 176 

Diseases or the Heart and Ar- 
teries 177 

Aneurism 180 

Diseases op the Skin and its Ap- 
pendages : 

Rashes and Eruptions 182 

Dandruff 189 

Malignant Pustule 190 

Boils 191 

Stye 192 

Carbuncle 192 

Chilblains 194 

Itch 195 

Barbers' Itch 196 

Corns 196 

Bunion 197 

Warts , 197 

Birth-marks and Moles 198 



CONTENTS. 



Vll 



PAGE 

Baldness—The Hair 198 

Nails 202 

Diseases op the Brain, Spine, and 
Nervous System : 

Infla mm ation of the Brain 205 

Hydrocephalus 206 

Apoplexy 209 

Paralysis or Palsy 212 

Epilepsy 214 

Hysteria 216 

Catalepsy 218 

Low Spirits 218 

Chorea 219 

Convulsions 220 

Locked Jaw 220 

Neuralgia 221 

Insanity 223 

Delirium Tremens 22*7 

Dipsomania, or Thirst-madness .... 228 

Diseases mainly symptomatic of 
other Diseases, but requir- 
ing Treatment : 

Dropsy 229 

Nausea, Yomiting, Betching 230 

Abscess , 232 

Hiccough 234 

Wakefulness 234 

Nervousness or Irritability. ...... 235 

Nightmare 236 

Varicose Veins 236 

Fetid Purulent Discharges from 

the Ear 237 

Headache 237 

Haemorrhages 238 

Vomiting Blood 240 

Bleeding from the Nose 241 

Discharge of Blood from the 

Bladder 242 

Toothache 243 

Common Cold. 244 

Cough 246 

Diseases op Bone and Tendons, 

and Deformities: 
Inflammation of Bone, Caries and 

Necrosis 247 

Rickets 248 

Hip-joint Disease 248 

Spinal Curvature 249. 



PAGB 

Sprain 252 

Club-feet 253 

Anchylosis 254 

White-swelling 254 

Spina Bifida 255 

Wry Neck 256 

The Chapter of Accidents : 

Wounds 257 

Bites or Stings 259 

Bruises 261 

Concussion or Compression of the 

Brain 261 

Drowning 262 

Hanging 266 

Lightning-stroke 266 

Sunstroke 267 

Suffocation and Suspended Anima- 
tion 267 

Intoxication 269 

Burns and Scalds 269 

Cold 271 

Cramp 272 

Choking 273 

Pins and Needles 273 

Fainting 274 

Ulcers 274 

Gangrene 275 

Fish-hooks 277 

Poisons 277 

Irritants 279 

Antidote to Irritant Poisons 280 

Narcotics 281 

Antidotes to Narcotics 281 

Narcotic Irritants and the Treat- 
ment 282 

Fractures 283 

Dislocations 288 

Diseases of the Eye and Ear : 

Ophthalmia , . 293 

Blindness 296 

Cataract 297 

Glasses 298 

Deafness ,. 299 

Midwifery : 

Menstruation 303 

Suppression of the Menses 304 

Profuse Menstruation 305 

Leucorrhoea, or Whites 306 

Chlorosis or Green-sickness 308 



vm 



CONTENTS. 



PAGE 

Pregnancy. 309 

Accidents of Pregnancy 312 

Abortion 313 

Premature Birth 314 

Labor or Childbirth 315 

Placenta Prsevia 318 

Flooding 318 

Puerperal Convulsions 319 

Management of the Infant 320 

Puerperal Fever 321 

Insanity, Puerperal 322 

Milk Fever 322 

Gathered Breast 323 

Cracked Nipple 324 

White Leg . . - 325 

Children and their Diseases: 

Feeding 326 

Weaning ., 327 

Diseases ! 329 

Dentition 331 

Mumps 333 

Thrush 334 

KedGum 335 

Milk Crust 335 

Cholera Infantum 336 

Pneumonia, Pleurisy, and Bron- 
chitis 342 

Materia Medica : 

Emetics 344 

Cathartics 345 

Diuretics 345 

Diaphoretics 346 

Expectorants 347 

Emmenagogues 348 

Antispasmodics 349 

Anthelmintics 349 

Alteratives 350 

Tonics 350 

Anodynes . . I 350 

Narcotics 351 

Stimulants 352 

Antacids 352 

Astringents 353 

Escharotics 354 

Demulcents 355 

Epsom Salts 356 

Senna 357 

Sulphur or Brimstone 359 

Rhubarb 360 



PAGE 

Magnesia 361 

Jalap 362 

Aloes 363 

Castor-oil 363 , 

Gamboge 364 

Colocynth 365. 

Wild-cucumber ■ 365 

Croton-oil 366 

Manna 366 

Rochelle Salts 366 

Resin of Podophyllum 367 

Scammony 367 

Seidlitz 367 

Seltzer-water 368 

Charcoal 368 

Ipecacuanha 368 

Antimony , 369 

Mustard 370 

Squill 371 

Zinc 371 

Blue Vitriol 372 

Lobelia 372 

Balsam of Peru 372 

Balsam of Tolu 373 

Seneka 373 

Benzoin 373 

Myrrh 374 

Sanguinaria 374 

Serpentaria 374 

Dover's Powder 374 

Spiritus Mindereri 375 

Nitre 375 

Sweet Spirit of Nitre 376 

Juniper 376 

Digitalis 377 

Buchu 377 

Copaiba 378 

Cubebs .• 378 

Cantharides 379 

Uva Ursi 379 

Pareira Brava 379 

Dulcamara 380 

Eupatorium 380 

Iron 381 

Bismuth 382 

Manganese 383 

Cinchona 384 

Quinine 385 

Simaruba 386 

Gentian 386 



CONTENTS. 



IX 



PAGE 

Quassia 387 

Willow-bark 387 

Nux-vomica 387 

Strychnine 388 

Citrate of Quinine and Iron 389 

Sage 389 

Chamomile-flowers 390 

Wormwood 390 

Calumba, or Calumbo 390 

Mercury 391 

Iodine 393 

Cod-liver Oil 395 

Sarsaparilla 396 

Guaiacum 397 

Arsenic 398 

Taraxacum 399 

Alcohol 400 

Gin 401 

Eau de Cologne 401 

Cajeput-oil 402 

Capsicum 402 

Pepper 403 

Cinnamon 403 

Ergot of Eye 404 

Ginger 405 

Ether 405 

Hoffman's Anodyne 406 

Chloroform 406 

Savin 407 

Ammonia 407 

Ammoniacum 409 

Potash 409 

Soda , 410 

Lime 412 

Opium 413 

Belladonna. . . 415 

Stramonium or Thorn-apple 416 

Hyoscyamus 416 

Conium 417 

Hops 417 

Camphor 418 

Hydrocyanic Acid 419 

Aconite 420 

Veratrum and Veratria 420 

Cimicifuga 421 

Colchicum 421 

Valerian 422 

Musk 422 

Assafoetida . ? 423 

Castor 423 

Alum 423 

Nutgall 423 



PAGE 

Catechu 424 

Matico 424 

Tannin 424 

Kino 425 

Creosote 425 

Krameria 426 

Lead 426 

Male Fern 427 

Pink-root 427 

Salt 427 

Kousso 428 

Turpentine 429 

Pumpkin-seeds 430 

Santonin 430 

Cold 430 

Dalby's Carminative 430 

Arnica 431 

Poppy 432 

Godfrey's Cordial 432 

Ox-gall 433 

Gregory's Powder 433 

Glycerine 433 

Borax 433 

Bromide of Potassium 434 

Paregoric Elixir 434 

Iceland-moss 434 

Gum- Arabic 435 

Liquorice 435 

Flaxseed 435 

Hydrochloric Acid 436 

Nitric Acid 436 

Sulphuric Acid, or " Oil of Vitriol" 436 

Citric Acid 437 

.Gallic " 437 

Oxalic " 437 

Carbonic " 438 

Vinegar 438 

Other Curative Agencies : 

Electricity 440 

Galvanism 441 

Magnetism 442 

Bathing 445 

Friction 449 

Fumigation 450 

Bleeding 451 

Cupping 454 

Leeches 455 * 

Blisters 457 

Issue 459 

Plasters 460 

Poultice 461 

463 



SUMMAEY OF PHYSIOLOGY. 



DIGESTION. 

Digestion is the process by which food is prepared in the ali- 
mentary canal, and put in such state that the organs more im- 
mediately charged with nutrition can absorb it. It is a complicated 
process, and one for the right performance of which many organs 
must act together. Digestion is not, as is popularly thought, ex- 
clusively the function of the stomach. It is begun while yet the 
food is in the mouth, and is continued in the parts of the intestine 
below the stomach, and the greater part of the canal may very prop- 
erly be called the digestive tract. Certain portions of our food un- 
dergo change in the mouth, certain other portions in the stomach, and 
others again in the small intestine. Digestion in full, therefore, re- 
sults from a division of labor between the several parts of the tract, 
one part not possessing the power to act upon those substances that 
should be digested in another part. Several juices, the secretions or 
peculiar product of different portions of the alimentary canal, are 
efficient agents in the process of digestion. These are : 

1. The saliva, secreted in the mouth. 

2. The gastric juice, secreted in the stomach. 

3. The bile, formed in the liver, retained in the gall-bladder as in 
a reservoir, and discharged into the intestine at a short distance 
below the stomach while digestion is in progress. 

4. The pancreatic juice, formed in the pancreas, and discharged 
into the intestine just below the stomach. 

5. The intestinal juice, secreted in the part of the intestinal 
canal distinctively called the small intestine. 

Food is first torn and crushed in the mouth by the action of the 
teeth ; and this is a fact of no inconsiderable importance in the se- 



2 SUMMARY OF PHYSIOLOGY. 

ries, for food that is " bolted," or passed down to the stomach not thus 
crushed and torn, is often a serious embarrassment to the organ ; and 
this embarrassment, and the overlabor and expansion it occasions, 
are the starting-points of dyspepsia. Good teeth, therefore, and the 
habit of using them well on the food, are of great consequence in 
the right performance of this function. During the time, moreover, 
in which the feeder supposes he is merely chewing his food, another 
process is going on. The saliva, or digestive fluid of the mouth, is 
then intimately mixed with the alimentary mass, by the action of 
the teeth, tongue, and cheeks, and this juice is thus enabled to act 
on all those particles of food over which it has any power. 

All the materials of our food may be resolved into three prin- 
cipal kinds : 

1. Starchy substances. 

2. Albuminous substances. 

3. Fatty substances. 

Of these, the first kind only becomes fit for nutrition, when it 
has undergone certain changes which convert it into sugar ; and the 
intimate mixture of the food with the juices of the mouth has some 
relation to this change. The change is not effected by these juices 
ordinarily, save in a slight degree ; yet any person may observe 
that, if he chews a piece of dry bread in which he knows there has 
been no sugar put, and retains it in his mouth long enough to 
completely masticate it, it will have acquired a taste like sweetened 
cake. Sugar has been made in his mouth by the change of the 
starchy part of the flour. Perhaps it is by its action in rendering 
food more palatable, and so exciting the stomach to its reception, 
and stimulating the flow of gastric juice, that this fact assists in 
digestion. 

Carried down to the stomach, the contact of the food stimulates 
the organ and provokes the flow from its internal surface of the gas- 
tric juice. This fluid possesses the property of reducing to a liquid 
form all that portion of our food that is called albuminous, mainly 
all animal substances, meat, eggs, etc. Its action is assisted by a 
regular churning movement of the stomach, which begins as soon as 
food is taken, and continues while there is any present. By this 
movement the food is carried alternately from one end of the 
stomach to the other ; but the walls of the stomach, though they 
may be said to grasp the food in this movement, do not in any sense 
grind or crush it ; the purpose of the movement being apparently 
to more intimately mingle the juice and food together, to secure the 
effective action of the former on all the parts of the alimentary mass 
that it changes. 



DIGESTION. 3 

Dr. Beaumont studied this subject on a man in whom an injury 
had torn an opening through the side and into the stomach, and 
who recovered from the effects of the wound, though it healed so as 
to leave a permanent aperture. He made from his experiments an 
estimate of the comparative time necessary for the digestion in the 
stomach of various articles, the time ranging from one to five 
hours. 

As the mass of food is in the stomach, this organ selects and di- 
gests the albuminous portions, and all the rest passes through into 
the small intestine, there to be acted upon by the other diges- 
tive fluids. Starch, which forms so large a part of our vegetable 
food, in potatoes, corn, wheat, and other grains, is promptly con- 
verted to sugar by the fluid of the small intestine, and is taken up 
by the system in that form. All fatty or oily matters also pass 
through the stomach unchanged, save that they are rendered liquid 
by the heat. These are acted upon especially by the pancreatic 
juice, which has the property of minutely dividing the oil-globules, 
and making with them a mixture in which the fatty substances are 
sustained in a milky-looking fluid, with which they are absorbed. 

In the small intestine also all the mass comes into relation with 
the bile which begins to be discharged into this canal soon after 
food is taken. The mixture of the bile with the chyme, the name 
given to the fluid that results from digestion, at once induces pecu- 
liar changes. The chyme changes in color to a yellowish hue, loses 
its acid taste and sharp odor, and becomes bitter. 

The exact office of the bile is still in some degree a mystery. 
This fluid is the peculiar secretion of the liver, and is poured into 
the intestine at a proper time to mingle with the digested food ; 
and that is the last point to which animal chemistry has hitherto 
been able to trace the bile. It is not found below the small intes- 
tine, and therefore is not carried into that canal to be excreted or 
thrown out. Neither is it found in the vessels that absorb the nu- 
tritive contents of the intestine, and therefore it is not taken up or 
poured from the liver. These facts favor the thought that the small 
intestine is the ultimate destination of the bile, the place in which it 
performs its function; and that this function is to combine with 
and act upon the liquefied food, and to effect a change that is the 
last step in the preparation of food for the use of the system. It is, 
at all events, certain that food not thus acted upon by the liver does 
not sustain life ; upon food absorbed from an intestine into which 
bile does not enter, an animal starves to death, as numerous experi- 
ments have shown. 



SUMMARY OF PHYSIOLOGY. 



ABSORPTION. 



All the elements of food thus acted upon in the several parts of 
the digestive tract, digestion proper, or what is called primary di- 
gestion, is accomplished ; that is, the nutritive substances have under- 
gone those changes which prepare them for the use of the system, 
and make them fit to he carried into the blood, to become eventual- 
ly part of the tissue of the body. Absorption is the next step. 
This takes place in the small intestine into which all the digested 
matter from the stomach passes, and where, as we have seen, oc- 
curs the digestion of oily and certain vegetable substances. The 
lower orifice of the stomach, that which opens into the small intes- 
tine, is called the pylorus (or door-keeper), from the ancient notion 
that this part of the stomach possessed a peculiar tactile quality, by 
which it could distinguish whether the substances pressed against it 
by the action of the whole organ were fit to pass through, and per- 
mitted the passage of what was thoroughly digested, returning those 
not in a satisfactory state. It is not safe to say that this old notion 
is altogether wrong, though many undigested substances do get 
past the door-keeper. The apparatus of absorption is practically 
the whole internal surface of the small intestine — an extensive sur- 
face, for it should be remembered this tube is nearly twenty feet in 
length. Certain glands, embedded in the lining membrane of this 
tube, absorb from it, like so many little sponges, all the oily por- 
tion of the food, which is called chyle ; and these have therefore 
been called the chyliferous glands. They are also called the lacte- 
als, because, seen in the red mass of the intestine during the prog- 
ress of digestion, they appear of a milky whiteness, the little vessels 
that connect them running from one to another like milk-white 
threads. We have hitherto explained that it is the action of the 
pancreatic fluid upon the fatty substances that gives this milky ap- 
pearance. Passing from one to another of these glands, and elab- 
orated in this glandular system in some unknown way, the chyle 
at length comes to one larger than the rest, called the receptacle 
of the chyle, and thence by a direct duct is carried up through the 
thorax and discharged into the blood, by the subclavian vein, that 
is just anterior to the process of the oxygenation of the whole 
mass. But the glands that thus take up from the intestine the fatty 
parts of the food are not the most important of the organs of ab- 
sorption ; more important are the blood-vessels themselves, whose 
ultimate fine tubes are infinitely ramified in the mucous membrane. 
Through the permeable walls of these vessels the albuminous and 
saccharine substances in the intestine, mingled with or acted upon by 
the bile, pass directly into the circulating current. 



CIRCULATION OF THE BLOOD. 



5 



And thus by the lacteals, and by the direct absorption of the 
vessels, are deposited in the blood all the nutritious portions of the 
food that we have traced from, the mouth. 

There are, however, non-nutritious portions — the tough vegeta- 
ble fibre of husks and rinds, seeds of fruits, etc., and these pass on 
into the large intestine for excretion. 

CIRCULATION OF THE BLOOD. 

As the direct result of digestion and absorption, the nutritive 
material, therefore, is deposited in the current of the blood, to be 
carried to the various parts of the body. 




THE HEAET AND LAEGE BLOOD-VESSELS. 

. A, right ventricle ; B, left ventricle ; C, right auricle ; D, left auricle ; E, aorta or great 
artery ; F ; pulmonary artery ; G, arteria innoininata ; H, right and left carotids ; I, subcla- 
vian artenes ; K, vena cava superior ; L, pulmonary veins. 



SUMMARY OF PHYSIOLOGY. 



In health the whole mass of the blood makes the circuit of the 
system in about three minutes, moving much more rapidly at what 
we may call the commencement of its course in the large arteries 
near the heart, and more slowly toward the end in the veins. 
Calling the heart the starting-point, we find the blood forced 
from it simultaneously in two streams — each current receiving its 
impulse from the heart's contraction. The heart contracts every 
time we can feel it beat in the side, and its beat is caused by the 
contraction which elongates and narrows the organ, and lifting its 
point brings it in contact with the walls of the chest. The heart 
contracts, therefore, in the full-grown healthy man from sixty to 
seventy times in a minute; and each contraction forces out, in 
two directions, a quantity of blood that differs with the size of 
the heart ; between each contraction it dilates and receives a similar 
quantity. 

One of the streams thus driven sup- 
plies what is called the systemic cir- 
culation, the other the pulmonary. 
As each of these is quite different in 
character, and more especially different 
in its vital purpose, it is well to con- 
sider them separately. For the sys- 
temic circulation, the blood leaves the 
heart by the left ventricle, and the aor- 
ta, the great artery of the chest ; pass- 
ing by this membranous tube down 
through the chest and abdomen, and 
by the lesser tubes that leave the great 
one going to every organ and every 
part on the way. Near the heart, other 
arteries go off from the aorta, especial- 
ly the carotids, which carry blood to the 
brain and supply the head generally, 
and the arteries which supply the arms, 
auricle, and discharging blood toward In the descending course of the aorta 

the lungs ; b, left ventricle, surmount- . ° 

ed by auricle, and discharging blood to it gives Oil the Vessels that Supply the 

system. The direction of the arrows . . u J 

indicates the course of the blood. Ai- stomach, liver, and intestines general- 

though the ventricles are here shown - _• . . ' . . _ 

separately, it should be remembered ly, and the KldnevS. At its lower ex- 
that they are connected so that their . , . " , . . , -, 

contractions are simultaneous. Ob- tremity this great artery divides and 

serve that the line of the circulation ~ ,- . , . , . 

at b departs from the ventricle, the iorms two smaller arteries, which turn 

dark line at the other side enters the , . ,, . , '. tin i 

auricle, the line that departs from the respectively to the right and left, and, 

opposite ventricle goes upward to the • , r i_j.-i.i-i? _.-u 

lungs. passing through the. pelvis, form the 




a, right ventricle, surmounted by 



CIRCULATION OF THE BLOOD. 7 

femoral arteries of either leg. In all the system of arteries the 
vessels are ramified in the body substantially on the same plan as 
the Croton pipes are laid in our city, the great principal main giv- 
ing off pipes a little less, and these other smaller and smaller still, 
till every house and every closet in every house is fed with the 
fresh supply. So the blood-supply to the system is so complete 
that it is not possible for the point of a needle to .find an interspace. 
All the blood thus supplied is arterial blood, that is, it is bright 
red in color, contains all the principles that are necessary to nour- 
ish and vitalize the body, and is capable of* giving off to each part 
and to each organ those substances necessary to sustain it in its 
normal condition, or from which it must elaborate its own peculiar 
product or secretion. This is the blood that is the life of the flesh . 
From the same fluid the stomach makes gastric juice, and the gland 
in the corner of the eye makes tears. 

Having thus passed from the heart and by all the arteries, to 
nourish all the parts of the body, the blood effects this purpose 
in a system of vessels designated capillaries. In this system of 
vessels, that are perceptible only under the microscope, the blood 
comes in actual contact with the tissues — for the walls are so 
thin, and so permeable to the fluids, that there is a regular exchange 
to and fro through these walls ; all that the blood has to leave 
in a given part for nutrition and support passing out through the 
walls, while at the same time there passes in through the walls 
much that is to be taken away, and that is thus put into the bloorl 
vessels as into a waste-pipe. In the capillaries, therefore, the blood 
undergoes, great modification. It passes into this system of vessels 
from the arteries, it is received from this system into the veins ; 
in the arteries it was bright red in color, in the veins it is of a deep 
purplish blue. This change in color is the ordinary visible one, 
and this can of course only result from a great difference in compo- 
sition between the fluid that passed into the capillaries and that 
which comes out. It is in some respects the difference between the 
Croton water that passes into the house, and the sewerage that 
passes out ; in some respects only, for this is but the relation of 
analogy, as the comparison, though sufficient to give a familiar idea 
of the main point, is far from accurate. Passing from the capillaries 
into the veins, the blood goes again by these tubes to the heart, and 
is received into the part of that organ designated the right auricle, 
a little reservoir or receptacle at the upper part of the heart, on top, 
in fact, of the heart proper, and not of the same muscular and con- 
tractile character as that part of the organ which in divided into 
the two chambers known as the right and left ventricles. In this 
2 



8 SUMMAR Y OF PHYSIOL OGY. 

receptacle the blood accumulates during one contraction of the 
heart ; and from this, upon the dilatation of the heart, falls into the 
ventricle immediately beneath. 

We have thus described the circuit of the blood in the greater or 
" systemic " circulation, the purpose of which is to supply to all parts 
of the body a fluid charged with nutritive and vitalizing substances. 
The other circuit i£ the pulmonary or lesser circulation, the purpose 
of which is to revitalize and restore to its original life-sustaining 
character the blood that has been returned to the heart from the 
greater circulation. This purpose is accomplished by exposing that 
blood to the action of the air in the lungs. 

From the right auricle into which we had traced the blood that 
made the circuit of the body it falls into the ventricle of the same 
side. It is what is known as venous blood, a heavy purplish-blue 
fluid. The next contraction of the heart forces it out, and it is dis- 
charged by the pulmonary artery into the ' lungs, and into a sys- 
tem of minutely-ramifying vessels analogous to the capillaries, the 
correlatives of the capillaries. As in the capillaries the blood under- 
went changes that fed the system on one hand, and depurated -it 
on the other, in these vessels it undergoes the opposite changes — 
parting with what is noxious and receiving that which it is again to 
transmit to the several parts of the body. About four times the 
capacity of a single chamber of the heart is exposed to .the action 
of the air each time we draw our breath ; and the blood thus ex- 
posed gives off carbonic-acid gas and receives oxygen gas. As the 
most obvious result of this, it again changes color, and becomes 
once more bright scarlet. Moving on through the pulmonary capil- 
lary tissue, it passes through the pulmonary veins and enters the 
heart at the left auricle, from which it falls into the left ventricle, and 
at the next contraction is again impelled forward in the greater cir- 
cuit of the system. 

Such are the main points in the story of the circulation of the 
blood, a wonderful story only in its simpler facts, still more wonder- 
ful in its minutise ; a chapter in science that has had its martyrs 
too : for, in 1553, Michael Servetus, a Spaniard, who announced the 
fact of the circulation, was burned at the stake; and in 1628 Wil- 
liam Harvey, who fully demonstrated the fact, suffered for his dis- 
covery, for he was looked upon as a dreamer, and his practice, which 
before had been remunerative, declined till it was barely sufficient 
to maintain him. 



RESPIRATION. 



9 



RESPIRATION. 

An important object, therefore, of the circulation of the blood is 
this : to pass the whole mass alternately through two different sets 
of capillary vessels, in one of which it comes in contact with the air, 
is purified, and receives oxygen ; in the other, depositing this oxygen 
and receiving material, to be carried to the lungs and thrown out. 
Related to this function, then, and necessary to its complete perform- 




SECTION OF LUNGS SHOWING RAMIFICATION OF BRONCHIAL TUBES. 
A, trachea ; B and C, bronchial tubes ; D, ultimate bronchial tubes. 

ance, is the function of respiration. Respiration is the regular 
drawing of air by the nose, or mouth, and windpipe, into the lungs, to 
meet the blue venous blood that each pulsation sends up from the 
right side of the heart. The elastic walls of the chest, and the strong 
muscle (the diaphragm), that is, a sort of arched floor to this cavity, 
constitute an apparatus for. drawing in air. The diaphragm is at 1 



10 SUMMARY OF PHYSIOLOGY. 

tached all around at the lower extremity of the walls of the chesty 
and arches up in the centre to a great convexity ; contraction, short- 
ening each fibre of this muscular sheet, and drawing from the fixed 
points of its attachments in the walls, of the chest, obliterates the 
convexity, and the muscle becomes a flat plane : at the same moment 
other muscles, acting coordinately with this, expand the walls of the 
chest. By these means, the cavity is enlarged, and air, rushing in 
by the nose and mouth, fills it ; then, in a moment, the contraction is 
relaxed ; the diaphragm returns ; the walls, no longer drawn away, 
come again to a certain line, and the air is forced out. This bellows 
movement occurs naturally about eighteen times in a minute; any 
injury, or any disease, that prevents its regular or proper perform- 
ance, causes intense suffering, and any interruption of it, lasting for 
a few minutes, results in death by suffocation ; for, air not reaching 
the lungs, the blue blood that comes up is not changed, and goes on 
into the circulation again, not bearing oxygen to feed and sustain 
the system, but bearing the carbonic acid, which should have been 
discharged in the lungs, and which poisons and destroys : not vi- 
talized by the circulating fluid, but overpowered, the whole nervous 
apparatus, necessary to life, fails, and death ensues. From twenty to 
twenty-five cubic inches of air are changed in the lungs of a healthy 
adult at each act of tranquil breathing. This is not the capacity 
of the lung, for more can be taken in a forced inspiration ; and 
there always remains in the lung a quantity of air beyond the 
power of the individual to expel. The lungs may be regarded as an 
aerial reservoir, the average capacity of which is about two hun- 
dred and twenty-five cubic inches ; this reservoir is always full of 
air, in a condition to breathe — differing in temperature and other 
respects from the mass of the atmosphere ; and this is kept in a cer- 
tain standard condition of purity by the regular change, once in four 
seconds, of twenty-five cubic inches, or one-ninth the whole quantity. 

Exercise has a great influence upon the health, as it affects this 
process. Ordinarily, regarded only as favoring the development of 
the muscular system through use, its greatest importance is in 
reality that, stimulating the action of the heart, it compels the man 
to breathe more, and thus forces the use by the system of an in- 
creased quantity of oxygen. 

It is held by some physicians that certain of our more serious 
maladies depend upon a loss of relation between these correlative 
extremities of nutrition, the digestive and respiratory processes ; that 
if respiration, in the discharge of noxious principles, and the oxy- 
genation of the blood, do not keep pace with absorption, certain 
poisons causative of disease accumulate. 



ASSIMILATION AND SECRETION. 11 

ASSIMILATION AND SECRETION. 

Nutritive matters, flowing in the current of the blood, are at 
once the common property of the whole system ; and each part or 
organ draws from this general source of supply the substances that 
are necessary to sustain and support it, to maintain its healthy 
condition, and to enable it to perform its peculiar duty or function. 
In this every part possesses a power to assimilate to its own struct- 
ure and condition the elements carried to it in the blood, so that from 
the same fluid are formed bone to replace the waste of bony tissue, 
muscle, nerve, hair, skin — to replace the waste of these respectively. 
It is by these assimilations that the system is kept up ; and thus 
each organ is for itself the final factor in the process that begins 
with digestion. The organs support the system and maintain its 
state of health by the elaboration of their several secretions. Thus it 
is, as we have seen, with the bile. The capillary vessels that ramify 
in the walls of the small intestine, taking up in a fluid form the nutri- 
tive substances of each meal, are only the little tributaries of a con- 
siderable stream that flows in what is called the portal vein. This 
vein, the blood in which is thus surcharged with nutriment, does not 
go directly to the heart, but enters the liver. All the material of 
nutrition, therefore, as it is absorbed from the intestine, is carried 
immediately into the liver, excepting only the fatty substance, which 
by the lacteal and thoracic duct are led a roundabout way, and dis- 
charged into the venous current above this organ. In the liver 
there is another set of capillaries, and through these the blood goes, 
to pass out at the upper surface, and hurry onward to the heart. 
But, in passing through the capillaries in the liver, the blood leaves 
much of the material it has brought from the intestines — the liver 
taking all that is necessary for the elaboration of bile. Bile, thus 
made, is again discharged into the intestine, to take part in the same 
process of digestion. 

Bile is a greenish, viscid, bitter fluid, ninety per cent, water, which 
holds in solution minute portions of some peculiar salts of soda and 
potassa, and larger portions of phosphates of soda, lime, and mag- 
nesia, and some fats and fatty acids. But the analysis of bile gives 
no hint of that knowledge which would be most valuable in regard 
to it — exactly what function it performs in the support of the 
system. 

Other secretions, which are elaborated by the different organs 
from the blood they receive, are : mucus, the viscid, adherent matter 
that moistens and lubricates the various mucous membranes; se- 
baceous matter and perspiration, which keep the skin soft, and in a 



12 SUMMARY OF PHYSIOLOGY. 

condition to carry out certain portions of the waste of the body ; 
the tears, milk, saliva, and gastric and other intestinal juices. 

How blood is made is still another of the mysteries of the sys- 
tem. Analysis here also tells but little. It first divides the blood 
into two parts : a fluid part, called serum or plasma, holding in solu- 
tion fibrin, albumen, and certain salts ; and a solid part, consisting 
of the blood-corpuscles, or red globules of the blood, infinitely little 
disks of firm matter that float freely in the fluid, and in quantity 
form about one-half the whole mass of the blood. No doubt the 
distribution of the different portions of nutritive material to the vari- 
ous parts of the system, that succeeds each process of digestion, 
relates to blood-making, and that, in the several organs through 
which they pass, the elements of food undergo the changes necessary 
to prepare each for enriching and supplying the vital stream ; but 
the exact particulars of these changes, and the steps by which fat, 
fibrin, etc., are converted into the fluid that directly sustains life, 
are as yet unknown. 

EXCRETION. 

Strictly speaking, the secretion of each organ is excretion with 
regard to the whole mass of the blood ; and when, from any derange- 
ment in any organ, it fails to secrete its peculiar product, certain sub- 
stances are left in the blood, that perhaps always have a poisonous 
tendency, and lead to disease in proportion to their amount and 
character. This is one of the ways in which the disturbance of any 
part leads to disease of the whole system. But there are other .pro- 
cesses in the animal economy that are especially termed excretions, 
because their more immediate import is, that they carry out of the 
system altogether the effete particles that are the consequence of 
the processes of nutrition — the ashes that result from keeping up the 
fire of life. Three great emunctories perform this duty. In one of 
these, the lungs, we have already described this action in speaking 
of respiration. At every breath, while we take in the fresh air, we 
give forth air that was previously taken in ; and this latter is nearly 
without oxygen, and is charged with carbonic-acid gas instead ; and 
this gas, the waste of the system, is brought up to the lungs by the 
venous blood, to be thus cast out. Another of the emunctories is 
the skin, which also carries off carbonic acid, practically taking part 
in the office of respiration. The kidneys are the third. These 
organs constantly depurate the blood. The blood is, to use a word 
that describes the fact, if it does not exactly explain the method, 
filtered through the kidneys, and as it leaves them it is purified of 
substances that, if they remained in the current, would destroy life 



FUNCTIONS OF THE NERVOUS SYSTEM. 13 

by their poisonous nature. From the kidneys they are passed out 
of the body in the urine. These substances are constantly received 
into the blood by the changes of the system, and must be as con- 
stantly taken away by the kidneys ; hence any disease thaj incapa- 
citates the kidneys from performing this office is almost necessarily 
fatal. The commonest of the diseases that has this result is Bright's 
disease of the kidney, which usually renders the kidney useless to 
the system, and then the poison accumulating in the blood kills. 

FUNCTIONS OF THE NERVOUS SYSTEM. 

We have thus glanced over the whole range of the nutritive 
functions, and considered the processes by which man is kept alive, 
and we have seen that all these steps are somewhat in a circle ; the 
blood sustains by the nutrition it carries, and is sustained by that it 
gets ; and digestion, circulation, and respiration, end and begin in 
one another. The stomach acts to feed the blood, that the blood 
may enable the stomach to act as before ; the heart impels blood 
merely to get the power to impel blood again ; and the question 
naturally arises, Where does this all begin ? whence comes the first 
impulse ? We now go one step nearer to the answer to this inevi- 
table question in considering the nervous system ; let us keep in 
mind, however, that it is only one step nearer ; these questions in- 
volve the great secret of life — the origin and nature of the vital 
principle — and no man can fully answer them. Omnipotence has 
hitherto kept from us the knowledge necessary to that answer, and 
permitted us to soar toward this mystery only in vague guesses ; 
but whatever this vital principle is, we know that the brain and 
nervous system constitute in us the apparatus by which it acts in 
the production of that round of vital phenomena that we sum up in 
the one word — life. This is the great function of the nervous sys- 
tem, to receive from without, or, in accordance with some law of its 
nature, fixed by the hand of God, to create the vital force, and trans- 
mit it to the several organs that without it would be mere inert sub- 
stance. Exactly what the vital force is, would be the next question, 
for which, as yet, there can be no answer. 

Impressions from without made upon the system are called sen- 
sations ; but there is general sensation and special sensation ; general 
sensation is the simplest consequence of vitality, and is the com- 
mon attribute of every living animal body. It is an attribute also 
apparently of some plants, and .the rudimentary nervous system, upon 
which this sensation depends, is the machinery by which natural 
principles act on the lowest forms of life. According to impressions 
made on this machinery, the oyster, lying at the bottom of the 



14 SUMMARY OF PHYSIOLOGY. 

stream, receives the nutritious substance that comes in the water, or 
shuts his shell suddenly at the presence of danger. As we go higher 
in the scale of life, we find the machinery more and more devel- 
oped — more complex, accurate, and wonderful, but working on the 
same principles, or an extension of those principles — till in man we 
reach that marvellous apparatus consisting collectively of the brain, 
spinal cord, and the innumerable nerve-filaments that connect these 
great centres with every part of the organization, making it a unit. 

Special sensation, on the other hand, is the impression made on 
certain parts fitted to receive a particular stimulus ; such an im- 
pression as light makes on the retina of the eye, sound on the nerves 
of the ear, odors on the organs of smell, and the sapid qualities of 
substances on those of taste. 

From every part of the body thread-like nerve-fibres run to the 
brain and spinal cord, and from these other fibres run to every part 
of the body ; and there is no perceptible difference between the 
fibres, but they are known by their relation to other parts, and 
known to be different by the various offices they perform. Impres- 
sions are received in the nervous centre by one 'set, and the impulse 
that this impression stirs is conveyed by the other, and becomes an 
act : thus, if a man puts out his hand, and touches a stove that he 
thought was cold, and it is unexpectedly hot, the hand is withdrawn ; 
and the whole is done with such rapidity, that thought has had no 
time to take part. The act was involuntary ; nay, if a man is dozing 
by the fire, and his foot touches it, the foot will be withdrawn then 
also, although the impression made has not awakened the sleeper. 
In these cases, the impression of the presence of that which would 
injure is carried by one set of nerves to the nervous centre, and thence 
instantly is sent forth by other nerves the impulse that moves the 
muscles necessary to draw the foot or hand away. Thought, as that 
word is applied specially to the mental actions of man, never inter- 
venes here, for the same act occurs wherever there is life ; and that 
queer bravo of the water, the crab, possesses this natural provision 
for his safety in the highest degree. This is unconscious nervous 
action ; it exists where there is no brain, but only nerve-filaments, 
and a centre of low organization. 

In the lower forms of vitality the occurrence begins and ends 
with the two facts — the irritation and the act ; the nerves of sensa- 
tion have simply the power to receive and convey an irritation, the 
others simply the power to transmit a motive impulse ; and the lives 
of such creatures are only the succession of these events. But, as we 
go from lower to higher forms, we meet a new provision — the brain. 
The brain is a sort of store-house of records, in which, for the benefit 



FUNCTIONS OF THE NERVOUS SYSTEM. 



15 



of the organization, is preserved the result of its experiences ; ani- 
mals, therefore, provided with brains do not indefinitely repeat the 
same simple acts through a whole life. Having found by some ex- 
perience what things give pain and what pleasure, and being able 
to remember and distinguish these things ; perceiving thus, more or 
less clearly, their relations to their surroundings; acquiring a cer- 
tain dim consciousness of what they are, they are enabled to govern 
their movements in the struggle for life with more or less intelli- 
gence and economy of vital force, according to the greater or less 




SECTION OF THE BRAIN ON THE MEDIAN LINE. 

A, internal face of the left hemisphere at the great longitudinal fissure ; B, corpus callosum ; 
C, optic thalamus ; D, medulla oblongata ; E. the spinal column ; F, section of the cerebel- 
lum exhibiting the so-called arbor vitse ; G, left hemisphere of the cerebellum. 

development of the brain. There is a well-organized brain in some 
of the lower animals, as the horse- and dog ; but, in that distinguish- 
ing part of the brain the development of which depends upon vital 
experience, and which thus originates thought, man is separated 
from all others by an infinite distance. It is by this development he 
deserves his name ; for the word man is derived from a word signify- 
ing thought, and thus particularizes him as the thinking animal. 

At the upper part of the spinal marrow, this so-called " marrow " 
is expanded, and spreads out into what becomes the base of the 



16 SUMMARY OF PHYSIOLOGY. 

brain. This expanded portion of the column is called the medulla 
oblongata. Immediately above it and behind is the cerebellum or 
little brain, growing out from the posterior aspect of the cord. 
Above all, and filling the whole upper and anterior part of the skull, 
are the two great lobes of the brain proper. From their shape 
these are called the hemispheres. The name is not correct. The 
two, as they lie side by side, and considered together, form one 
hemisphere ; but if we use the plural, and thus recognize the division 
into right and left of these lobes, each lobe is nearer the half of a 
hemisphere. We note this point, to give an accurate idea of the 
form of these bodies. 

In the endeavor to trace the intellectual power to its exact seat, 
and to locate the vital principle, science has given more or less im- 
portance to various divisions of the brain, assigning certain func- 
tions to each. It is not safe to accept such conclusions as part of 
positive knowledge. We know, however, that the direct relation of 
the organs of the special senses with the brain is by certain points 
on its under surface. The olfactory bulb, for instance, is a small 
body lying on the under surface of the hemispheres, and it is 
through impressions made on this that we become conscious of 
odors. . The optic nerve proceeds from the base of the brain, but a 
little way behind this ; the auditory nerve behind that again ; but, in 
thus locating these, we do no more than show points of entrance into 
or departure from the brain, not seats of power. But it seems 
scarcely possible to doubt that the hemispheres are the seat of the 
intellect. The difference in the size of these is the characteristic 
difference between the brains of men and animals, and even between 
the brains of intellectual men and others. Idiocy coincides with a 
failure in their development ; and the powers of perception, remem- 
brance, and comparison, the elements of all reasoning, hold propor- 
tion with their size and health. 

SPECIAL SENSES. 

All impressions made upon the brain by external objects are re- 
ceived through the special senses — sight, smell, hearing, taste, and 
touch ; and the combination of parts, by which these senses act, is 
called the apparatus of each. 

THE EYE. 

The essential parts of the apparatus of vision are the optic 
nerve and the ball of the eye. To the outer circumference of the 
eyeball are attached slender muscles that act like cords running on 
pulleys, by means of which we change the position of the globe ; 



SPECIAL SENSES. 



17 



but it is as a chamber, and not as a ball, that we should regard this 
organ, for it is its cavity that is important in the sense of sight. 
The cornea, in the centre of which is seen the pupil, is merely a 
transparent point in the wall of the chamber, by which the rays of 
light enter. The eye, therefore, bears in its function a general re- 
semblance to the photographer's camera. The cavity of the ball is a 




VEETICAL SECTION OF THE EYE IN THE MEDIAN LINE. 

A, the cornea ; B, the anterior chamber ; C, the pnpil ; D, the iris ; E, the crystalline lens ; 
F, the zone of Zinn ; G, the ciliary processes ; H, the sclerotic coat ; I, the. choroid coat ; K, the 
retina ; L, the vitreons body ; M, the optic nerve ; N, the inferior rectus muscle ; O, the supe- 
rior rectus muscle ; P, muscle levator palpebrse which raises the eyelid ; Q,, R, lachrymal 
glands and ducts. 

darkened circular chamber, closed on every side ; at one side, how- 
ever, is a transparent point, through which rays of light penetrate, 
and this point may be made larger or smaller by the contraction or 
dilatation of the pupil. Just inside this transparent point, the rays 
of light, coming from every quarter, fall upon a lens, the crystalline 
lens, by which they are concentrated and thrown upon the posterior 
wall of the chamber. At this point in the wall of the cavity is the 
retina, an expansion of the optic nerve. On this nervous surface, 
sensitive to light, and created capable of receiving impressions by 
means of light, the rays refracted through the crystalline lens print 
an image of the body from which they are reflected. Thus, a picture 
of the thing presented to the eye is cast upon one extremity of a 
nervous cord, the other end of which communicates with the brain, 
and the further progress of perception science cannot follow. 

We are apt, in our ordinary use of words, to discuss a single eye, 
but the two eyes are parts of one apparatus. They are combined 



18 SUMMARY OF PHYSIOLOGY. 

within the skull, the optic nerves crossing each other before they 
enter the brain ; this explains the consentaneous action of the mus- 
cles moving either ball, as well as that active sympathy that 
weakens one when the other has received an injury. 

Clear vision — focus — is dependent upon the movement of the 
crystalline lens, which is carried forward or backward by muscles 
of its own. When this body cannot be moved far enough in either 
direction to focus an object at a given point, the person is said to 
be short-sighted or far-sighted ; and the cause is, the too great or 
too little convexity of the lens. The power of adaptation in the eye 
is analogous to what we see in the ordinary opera-glass, when a 
movable lens is carried nearer to the eye, or farther from it, accord- 
ing to the distance of the object we inspect. 




DIAGBAM SHOWING THE COUESE OF THE LUMINOUS EATS IN THE EYE. 

H M P, luminous rays reflected from an object ; h m p, luminous rays refracted, and painting 
an inverted image on the retina. 

Much of the nicety of vision, that seems to be quite unconscious, 
depends nevertheless upon education, as the judging of the distance 
of objects. Images, as they are thrown on the retina, are upside 
down, as on the object-glass of the camera. This is apparently rec- 
tified in the brain, but there have been persons in whom the rectifi- 
cation did not take place, and to whom consequently every object 
appeared inverted. 

THE EAR. 

The apparatus of the sense of hearing is comprised of the parts 
called the external, middle, and internal ear, and the auditory nerve. 
The parts of the ear, considered together, form a composite acousti- 
cal contrivance ; and the auditory nerve, connecting the brain with 
this instrument, receives and transmits the impressions of sound. 
Sound results from a change of the relation between the air and 
the ear. As a boat passes down a stream, breaking the still surface 
of the water into waves or ripples, we see each successive ripple 



SPECIAL SENSES. 



19 



strike its little blow on the beach : nearly this is what occurs in the 
air ; the contact of bodies, or the swift moving of any single body, 
gives rise to waves, or ripples, in the air, that are called vibrations, 
and these waves strike on the tense, thin membrane, the ear-drum. 
From the funnel-like form and peculiar character of the external 
ear, the concha, its office is readily recognized. It is to catch and 
direct inwardly the most delicate movements impressed upon the 
Thus, in those in whom the sense of hearing, from age or other 



air. 



causes, has become less acute, this external ear is supplemented by the 




SECTIOX SHOWING THE DIFFEEEXT PAET3 OF THE EAE. 

A, the external ear; B, the external auditory canal; C. the tympanum, or ear-drum; D, 
cavity Of the tympanum; E and M, the incus and malleus (anvil and hammer), small hones of 
the middle ear which convey the vibrations from the tympanum across the cavity to the internal 
ear ; G, semicircular canals : H, cochlea ; these are parts of the labyrinth in which are the rami- 
fications of the auditory nerve ; I, the Eustachian tube, running from the middle ear to the 
throat. 

larger funnel of an ear-trumpet. This trumpet performs, on a more 
extensive scale, the same office as the concha of the ear. From the 
concha to the middle ear runs the auditory canal, at the inner ex- 
tremity of which is the tympanum, the membrane against which the 
vibrating air strikes. This membrane is the external wall of a 
cavity, in the thickest part of the bones of the skull, in which, are 
all the other parts of the organ of hearing. In the simplest forms 
of the ear, such as occur in the lower animals, we find merely this 
cavity, filled with fluid, and with the branches of the auditory 
nerve distributed in the parts that line it. As we go higher, small 
bony substances are developed in the cavity, giving it new acoustic 



20 SUMMARY OF PHYSIOLOGY. 

powers ; and in man, though the acoustical cavity is still the essential 
fact, it seems of less importance than the various instruments it 
contains, the semicircular canals, and the cochlea in which is the 
expansion of the auditory nerve, and the three minute bones which 
connect this with the tympanum — the malleus, the incus, and the 
stapes. This perfected structure enables man, not only to hear, but 
makes him aware of the direction, distance, and quality of sounds. 

SMELL, TASTE, AND TOUCH. 

These senses all act on the single principle of giving us informa- 
tion by direct contact of the sensitive nerve-filaments with sub- 
stances or particles of substances : the differences by which one set 
of nerves gives information only of the odorous qualities of sub- 
stances, another of their sapid qualities, and a third of their form, 
density, temperature, texture, etc., are stamped in the innate character 
of the nerves themselves, and are beyond our knowledge. The 
olfactory bulb of the brain rests on a bony plane, that we may call 
the floor of the skull, just above the nose, and fine filaments from it 
are sent through the bone, and thickly distributed in the mucous 
membrane lining the nasal cavities : thus, if we close the mouth, and 
draw breath forcibly through the nose, we bring in contact with this 
membrane a considerable quantity of air, and the nerve-filaments in 
the membrane detect the quality of the air with respect to odors ; 
and thus also its respirable qualities, for the situation of this sense 
at the vestibule, as it were, of the respiratory tract, is a provision for 
our safety. 

As the sense of smell is provided that we may not receive injury 
from the air, so the sense of taste is placed at the commencement of 
the digestive tract, to guard against the noxious qualities of sub- 
stances apparently edible, Wild animals do not eat even the poi- 
sonous fruits that have an agreeable taste. Why sugar and salt affect 
this sense in their respectively different ways is all mystery. It has 
been conjectured that the difference depends upon the form of the 
ultimate particles of these bodies. Several nerves concur in this 
sense, and various parts of the cavity of the mouth. Though the 
sense is commonly associated only with the tongue, it resides also in 
the membrane covering the bony roof of the mouth ; and, in making 
thorough examination of the taste of a substance, we bring the two 
parts together. Both the sense of smell and the sense of taste must 
concur for the perfect action of what is generally considered the 
sense of taste. 

The sense of touch is a modification of common sensibility, and 
exists over the whole surface of the body, but in some parts is com- 



THE SYMPATHETIC SYSTEM. 21 

paratively obtuse. The hand is, in a peculiar, yet hardly a special 
degree, the organ of this sense ; as exercised in other parts, this 
sense gives us only the ideas of resistance and temperature, but the 
peculiar sensibility of the ends of the fingers, as well as the various 
ways in which these may be applied to the surfaces we investigate, 
conveys to the mind many other facts, and from these we reason out 
shape, size, and all other characters of bodies. It has been said that 
this sense is so delicate in some blind men, that they can detect 
those differences in surfaces that are dependent on color. 

THE SYMPATHETIC SYSTFM. 

Through the nervous system, of which the great centres are the 
brain and spine, and which is thence called the cerebro-spinal sys- 
tem ; and especially through those adjuncts of that system, the or- 
gans of special sense, we become conscious of all that we know, and 
we perform all the acts of which we are capable. The functions of 
the nervous system have been classed as the functions of relation, 
because it is through them that we are social creatures ; that we 
laugh or weep, buy or sell, will and work our own destiny. There 
is another nervous system, called the ganglionic, or system of or- 
ganic life; it is the system of unconscious and involuntary vital- 
ity. Consciousness and will belong to the first system ; but there 
are certain processes that go on outside of our knowledge, over 
which our will can have little or no effect, and that, whether we 
sleep, or wake, possess the right use of our reason, or are without it, 
continue the same. The heart beats, the blood circulates, the stom- 
ach digests its contents, the body grows, and merely by willing we 
can never assist nor prevent any of these. Comparatively little is 
known of the exact action of this system, still less that can give to 
the general reader a satisfactory idea of its place in the economy ; 
but it is through this system that the sympathies of the various parts 
are so delicate and ready that one organ cannot be deranged in its 
actions without interfering in some degree with all the rest ; for 
through it the stomach, heart, lungs, brain, and other organs, are 
joined in a common existence. 



ANATOMICAL DESCRIPTION OF IMPOKTANT 

OKGANS. 



ABDOMEN. 

This division of the body contains the stomach, intestines, liver, 
spleen, pancreas, kidneys, etc. It is lined within by a membrane 
called the peritonaeum, defended on either side by the short ribs, and 
covered with the abdominal muscles, which, by their relaxations 
and contractions, in the act of breathing, assist digestion, and give 
the necessary secretive and expulsive motions to the surrounding 
parts. The abdomen is bounded above by the diaphragm, and below 
by the pelvic bones, forming the pelvic cavity, with which it com- 
municates ; at the front and sides are the abdominal muscles, which 
also extend backward to the vertebral column, or spine. This is the 
largest cavity of the human body, and, for convenience of descrip- 
tion, it has been mapped out into three zones, upper, middle, and 
lower, and several parts, or regions. That in the centre at. the top 
is called the epigastric region ; those on either side of it are the hy- 
pochondriac; next in the centre is the umbilical ; right and left of 
which are the iliac ; below these are the inguinal ; and between 
them the hypogastric, forming the lower central division. 

The abdominal contents are thus situated : Below the chest and 
next to the diaphragm is the liver, extending from beneath the 
right ribs across to the left, and having the largest development on 
the former side. Next to this is the stomach, the smaller end of 
which is situated in the epigastric and the larger in the left hypo- 
chondriac region, where it comes in contact with the spleen. Be- 
hind the stomach lies the pancreas. In the middle zone lies the 
large bowel, with a portion of the small intestines ; and behind 
these, close to the spine, are the kidneys. The small intestines also 



STOMACH. 



23 



pass down the centre part of the inferior zone, as do laterally the 
ends of the large intestines, or colon ; and there also we find, when 
it is distended, the upper portion of the bladder. 

STOMACH. 

This is a membranous bag, situated immediately under the dia- 
phragm. It varies much in size, according to the amount of dis- 
tention it undergoes. When not unnaturally distended, but contain- 
ing an ordinary meal, it is about ten or twelve inches in length, 
and from four to four and a half inches in diameter at its widest 
part. 




TEANSVEESE SECTION OF THE ABDOMINAL AND THOEACIC CAVITIES. 

a, the heart; bb, the lungs drawn aside to show the heart; c, the diaphragm, dividing the 
two cavities ; d, the liver ; e, the gall-bladder ; /, the stomach ; g, the convolutions of small in- 
testine ; A, the transverse colon. ' 

The stomach itself consists of four coats, or membranes, which 
are held together by means of the cellular tissue that we find every- 
where entering into the composition of the parts of the body. 

The external of these coats consists of what is called serous mem- 
3 



24 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

brane, and is a part of a great bag of serous membrane, the perito- 
naeum, which covers the whole of the abdominal viscera, the vis- 
cera being thrust, as it were, into this bag from the outside, 
the inner sides of the bag being kept constantly moist, so as 
to lubricate the external part of the stomach and other organs, 
and thus prevent any friction from the movements of the' 
body. The part of this membrane which covers the stomach is 
thin, smooth, transparent, and elastic, and immediately covers the 
second or muscular coat. This coat is composed of muscular fibres, 
which are distributed in three different directions. There is a set 
of fibres passing from the oesophagus directly along the stomach. 
Under these is another set, which passes round the stomach in a 
circular manner ; and under these are others, passing in an oblique 
direction between the two others. 

These fibres, like all other parts of the muscular system, possess 
a power of contraction ; and, when the food is in the stomach, it is 
by means of these muscles that the food is moved round and round, 
and ultimately propelled to the pyloric extremity of the stomach, 
previous to passing into the duodenum. The direction of the fibres 
indicates at once the functions they have to perform ; under the mus- 
cular coat is a quantity of cellular tissue, called the submucous, 
vascular, or cellular coat. It is upon this coat that the mucous 
membrane of the stomach rests, and in which the blood-vessels are 
distributed before they pass to supply the mucous coat. All these 
membranes are found to a greater or less extent in the whole of the 
alimentary canal. 

The most important of the coats of the stomach is the internal, 
or mucous. It is constructed in the same way as the whole of the 
mucous membranes, which everywhere form the interior Of the pas- 
sages leading into or from the internal organs. This membrane 
consists of two parts ; of an under layer, called corium, which rests 
always on the submucous cellular tissue, and is composed of a layer 
of fibres and vessels, varying much in thickness in different parts ; 
and of a very thin lamella, called basement-membrane, on which are 
formed the epithelial cells. These cells vary much in size, shape, 
and number, according to the part of the mucous membrane on 
which they are found. The external surface of all mucous mem- 
branes is kept moist with a secretion called mucus. In diseases 
of the mucous membranes, this secretion may be either entirely 
arrested, or increased to an unnatural extent. In inflammation of 
these membranes, the secretion in the first stages is often entirely 
suppressed, and subsequently greatly increased. This is not un- 
frequently the case in common cold. 



CESOPHA G US.— INTESTINE. 25 



(ESOPHAGUS. 

This is the passage by which the food is carried from the mouth 
to the. stomach ; it is a carved canal, or tube, extending from the 
throat, or fauces, to the stomach, and is narrowest at the upper end, 
where there is the greatest liability of a stoppage by an attempt to 
swallow any substance too large for the passage. 

The oesophagus is composed of two layers of muscular fibres, 
the external being placed longitudinally, and the internal disposed 
in circles, by the contraction and expansion of which the food is 
propelled downward ; the passage is lined with a layer of soft mu- 
cous membrane, and a moderately thick cuticle, which is a continua- 
tion of that of the lips and mouth. 



INTESTINE. 

That tubular portion of the abdominal contents which extends 
from the stomach to the anus, and is formed of a peritoneal, muscu- 
lar, and mucous coat, united by cellular membrane, is thus called. It 
is divided into small and large intestine ; the first of which has three 
divisions, severally distinguished as the duodenum, jejunum, and 
ileum. The duodenum begins at the pylorus, or lower part of the 
stomach ; it bends first backward, then downward, and then across 
the body, being partially covered by the peritonaeum, and so runs into 
the jejunum, so called from its being usually empty. The small in- 
testine opens by the ileo-caecal valve into the large intestine, which 
has also three divisions : first, the caecum, or head of the colon ; 
second, the colon proper ; third, the rectum. The colon, which con- 
stitutes almost the entire length of the large intestine, is termed, as 
it ascends from the right lumbar region, the ascending colon, as it 
crosses the abdomen, the transverse arch of the colon, and as it de- 
scends into the left lumbar region, the descending colon. In the iliac 
region it forms a double curve like the letter S, and that part is thence 
called the sigmoid flexure of the colon ; the fold of the peritoneum 
which invests it being termed the iliac meso-colon. 

The termination of the large intestine is the rectum, or end of the 
alimentary canal, so called because it is nearly in a right line ; here 
the covering called the peritonaeum ceases, and the intestine accom- 
modates itself to the hollow of the pelvis, having its external open- 
ing in the anus, the sphincter of which, a strong circular muscle, 
guards it. 

The whole of the intestinal canal is a continuous tube about six 



26 . ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

times the length of the body, the first three-quarters of it comprising 
the small and the last quarter the large intestine ; the calibre of the 
tube of the latter portion is much greater than that of the former ; 
the caecum, the largest of all, being at least three times greater than 
the ileum. 

THE LITER. 

This is the largest glandular apparatus in the body, and one of its 
most important offices is to secrete the bile ; it is divided into three 
lobes, viz., the greater, the smaller, and the lobulus Spigelii. The 
first is situated in the right hypochondriac region of the abdomen ; 
the second in the epigastric region ; and the third in the left side of 
the great lobe, having two prolongations, which have been termed 
the lobulus caudatus and the lobulus quadratus. 

The liver weighs on the average about four pounds. Although 
to the naked eye it looks like a solid substance, it is yet what is 
called a compound gland, that is, made up of a number of smaller 
glands, bound together by cellular or areolar tissue. Each of these 
little glands, or lobules, as they are called, is about the size of a 
millet-seed, and is composed of a minute ramification of the hepatic 
artery and vein — the vessels whose special office it is to afford nutri- 
ment to the liver — of a branch of the portal vein by which the blood 
returns from the intestines through the liver to the heart, and which 
is forced into the cells of the duct which conveys the bile off from 
the liver. There is no doubt now that the bile is entirely secreted 
from the venous blood. From this fact we can well understand how 
any impediment in the flow of blood from the liver to the heart is 
likely to cause congestion of the former organ, and how, on the other 
hand, any obstructions in the liver are likely to act upon the heart, 
and cause irregularity of operation there ; thus, with sluggish liver, 
we get febrile and often irregular pulsations. As soon as the bile is 
formed, or secreted in the cells of the liver, as much of it as is re- 
quired to form chyle passes into the digestive canal, while any over- 
plus passes into that convenient reservoir the gall-bladder. 

Having thus an important duty to perform in the animal econ- 
omy, it is of the utmost consequence that the liver should be kept 
free from disturbing agencies, so that it may be in a proper con- 
dition for the discharge of its functions. The evil to which it is 
most liable is a disturbance of its circulation, causing either active 
or passive congestion, both of which are common conditions of the 
organ. 



GALL-BLADDER, KIDNEYS, BLADDER. 27 

GALL-BLADDER. 

The receptacle for the bile is situated on the concave side of the 
liver, and lies upon the colon, part of which it tinges with its own 
yellow color. It is about the size of a hen's-egg, and the shape of a 
pear. This bladder must be sought for beneath the right lobe of the 
liver, at about the boundary-line between the epigastric and right 
hypochondriac region. The bile secreted by the liver is here col- 
lected, retained for a certain time, until rendered more fit for its 
office by admixture with the peculiar produce of the bladder, and 

then expelled. 

KIDNEYS. 

These are the two glandular organs that secrete the urine : they 
are situated at the lower back part of the abdomen, below the ribs, 
and above the hip-bones, one at either side of the spine. Each kid- 
ney forms a firm, fleshy mass, which is enclosed in a fibrous capsule, 
the outer and tougher membrane being lined with a soft and smooth 
mucous membrane, which forms a continuation of that which lines 
the ureter and the bladder. On section the kidney appears formed 
of two different substances — the external, or cortical, and internal, or 
medullary portions. The medullary portion is arranged in cone-like 
forms, and the cortical has a plain, granular surface when cut. The 
granulated appearance of the cortical portion of the kidneys is ow- 
ing to the globular expansions of the roots of the capillary tubes, 
which form the cone-like structures of the inner part, and present, 
when viewed through the microscope, a very beautiful arrangement, 
consisting of bundles, or fasciculi, of hair-like filaments ; each bundle 
together forming what is called a process, and opening into one of 
the calices of the pelvis, in a nipple-like projection, having several 
minute orifices. On all these little canals, called tubuli uriniferi, 
tiny blood-vessels ramify and spread down to the rounded 
bodies, called the corpuscles of Malpighi ; here it is that the nrine 
is secreted, or separated from the blood, and from hence it is con- 
veyed by the tubuli into the calices, and then through the pelvis of 
the kidneys into the ureter, and by these down to the great reservoir, 
the bladder; from thence, by means of muscular contraction, to be 
forced out by the proper channel, when a sufficient quantity has accu- 
mulated. 

BLADDER. 

A thin membranous bag, which serves as a receptacle for the 
urine, secreted by the kidneys, until it is voided through the ure- 
thra. This organ is situated in the pelvis, just below the pubic 
bone ; when much distended, it rises above this into the abdomen : 



28 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

it is composed of four distinct layers, or coats, viz., the external, or 
serous, muscular, areolar, and mucous, this last being the lining 
membrane. The bladder is angular in shape, and flattened against 
the pubis, when empty ; when full, a longish oval. The ureters, 
which extend from each kidney to the back of the bladder, pass 
through the coats of this organ obliquely, so that when it is dis- 
tended its distention acts to prevent return of the fluid. In the fe- 
male, the urethra is short and straight. In the male it is about nine 
or ten inches long, and considerably curved. 

THORAX. 

That part of the body which contains the heart, lungs, and the 
larger of the blood-vessels. It is separated from the abdomen by the 
diaphragm ; up the back of it passes the spine, in front is the ster- 
num or breastbone, and on either side it is bounded and guarded by 
the ribs. Enclosing, as it does, the great organs of circulation and 
respiration, and the main arterial and venous channels, this is one 
of the most important cavities of the body. With regard to its ex- 
act position, very erroneous ideas are often entertained, a pain in 
the pit of the stomach being frequently referred to the chest. 

Narrow-chested persons are, it is well known, predisposed to 
pulmonary complaints, and every possible means should be taken, 
when young, to expand this part of the frame. 

THE HEART. 

This is the great central organ of circulation. Its form is that 
of an irregular cone, having its base directed backward toward the 
spine, and its point forward and downward toward the left side ; so 
that at each contraction it may be felt striking between the fifth 
and sixth ribs, about four inches from the median line. In this po- 
sition it rests upon the diaphragm, having the surface on which it 
lies much flattened. On its right side, it is firmly attached to the 
diaphragm, which, it should be remembered, is the muscular parti- 
tion between the chest and abdomen; and behind, by the vena 
cava, or trunk vein, which passes through the diaphragm. Behind 
and above, the heart is also attached, although somewhat loosely, 
to the upper and back part of the chest, by the vessels which there 
pass out of the pericardium, or membranous bag in which the heart 
is enclosed. In a healthy state, the pericardium is lined with what 
is called the serous membrane, which is smooth and moist, and con- 
stitutes its inner coat, or layer, the outer one being fibrous. This 
membrane is also reflected, so as to give the heart two coverings, 



HEART. 



29 



which, at every motion of the organ, glide smoothly over each other, 
and thus prevent friction. 

The heart may be popularly described as a hollow muscle, hav- 
ing four cavities, two on each side ; its action is that of a kind of 
double pump, intended to carry on the twofold circulation, viz., 
through the body, and through the lungs ; the auricle and ventricle, 
on the left side, being devoted to the former, and those on the right 




HEART AND LUNGS. 

a, a, lungs with their anterior borders turned aside to show the heart and bronchial tubes ; 
d, heart; c, aorta; d, pulmonary artery; e, superior vena cava ; /, trachea or windpipe ; g, g, 
bronchial tubes ; h, h, carotid arteries ; i, i, jugular veins ; ,;', j, subclavian arteries ; Tc, k, sub- 
clavian veins ; p, p, cartilages of the ribs ; g, anterior cardiac artery; r, right auricle. 

to the latter. (See " Physiology," Art. Circulation.) Between the 
cavities on one side, and those on the other, there is no natural com- 
munication, but each auricle is connected with its corresponding 
ventricle, by a valve which only opens by pressure on one side, so 
that the blood cannot pass except in the right direction ; any at- 
tempt to return being instantly resisted by the closing of the valves. 



30 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

Should these become diseased, so that they perform their office im- 
perfectly, there will be regurgitation, or passing back of the blood, 
and that occasions serious derangement of the balance of circula- 
tion. These valves, which are also placed where the blood-vessels 
enter the different cavities of the heart, consist of membranous 
folds, and are, according to their form, either sigmoid or semilunar. 
It was the opinion of Harvey that the heart was the sole agent 
by which the circulation was effected, but we now know that there 
are several other agents that exercise at least auxiliary powers. 
There is no doubt, however, that the heart has a marked influence 
upon all parts of the circulation : thus, in the large arteries, we may 
note that the increase of the current, set in motion, exactly corre- 
sponds with the contraction of the ventricles ; and this is observed 
also in the smaller arteries at an interval scarcely appreciable : in 
the capillaries even, there is an occasional pulsatile motion to be 
seen in the transparent parts of an animal by means of the micro- 
scope. In the veins, also, we find this influence exerted. If the 
main artery and vein of a limb be exposed and isolated, and an 
opening made in the latter, the flow of blood may be regulated 
pretty exactly by compressing the artery, and thus, as it were, cut- 
ting off from the vein the supply given to it by the impulse of the 
heart, whence we may likewise note, that it not only by its con- 
traction propels the blood, but in its expansion it acts as a sucker to 
draw it up, so that it is at once both a sucking and a forcing pump : 
and such is the power of its action that the whole mass of the circu- 
lation, about twenty-eight pounds, goes through the system in the 
space of three minutes. 

LUNGS. 

These are two vesicular organs situated in the thorax, the cavity 
of which, together with the heart and larger blood-vessels, they 
nearly fill up ; so that, when the walls of this cavity are compressed, 
the air is forced out of the minute air-cells, of which the lungs are 
composed, into the several elastic membranes (the bronchi) con- 
nected with them; these bronchial passages afterward unite, and 
form one tube, the trachea, or windpipe, through which the air pass- 
es upward and downward in the act of inspiration and expiration, 
or breathing. 

If we examine the structure of the lungs, we find that it is po- 
rous, like a sponge. When, by the action of certain muscles, the 
capacity of the chest is increased, the air rushes in to fill the vacu- 
um, and expansion pi the lungs takes place ; then, the muscular 
movement ceasing, the ribs, by their weight and elasticity, contract 



LUNGS. 31 

and force out the air, and this alternate expansion and contraction 
constitutes breathing, in the act of which we see the chest rise and 
fall. The tubes, air-cells, and blood-vessels of the lungs are held 
together by what is called cellular tissue, and the whole are envel- 
oped in a membrane which covers their surface, and also the under 
surface of the ribs, for which latter purpose it is reflected back ; this 
membrane is called the pleura. 

We know that the action of the lungs may be forced or in- 
creased by an exercise of the will ; in this case, other muscles than 
those usually employed are called into play ; hence, the stoop in the 
shoulders, often observed in asthmatic people, and others with 
whom breathing is difficult. Mental emotion, and increased bodily 
exertion, will also cause an accelerated action of the lungs, as will 
those inflammatory and other diseases which stimulate arterial ac- 
tion. From fifteen to twenty-two is the average number of respira- 
tions in a minute, under common circumstances; but this number 
may be, and often is, very greatly increased by excitement, exer- 
cise, or disease. 

The average weight of the lungs in a healthy condition is about 
forty ounces ; they are, as we have seen, of a conical shape, embracing 
the heart between them, being internally concave to receive this 
organ, and externally convex to suit the concavity of the chest. In 
their narrow part upward they extend a little above the first rib, 
their broad and concave bases resting upon the diaphragm, and 
extending farther down behind than before : their color is a pinkish 
gray mottled with black. They hang free in the chest, except where 
they are attached to the spine, or rather to the mediastinum, by the 
pulmonary arteries and veins, and by the bronchial tubes on either 
side. The areola, or cellular tissue, which connects together the 
arteries, veins, or cells, etc., is called the parenchyma of the lungs, 
and constitutes the second distinct tissue, of which they are com- 
posed ; the first, or outer, being the pleura, and the third, or inner, the 
mucous lining of the air passages, or cells, into which the air enters 
when we breathe. So great is the number of these that they have 
been calculated to amount to 170,000,000, forming a surface thirty 
times greater than the human body. Every one of these cells is 
provided with a net-work of blood-vessels, by means of which the 
blood is brought into immediate contact with the air over every 
portion of their surface. When this great amount is taken into con- 
sideration, we shall at once feel how necessary it is to supply pure 
air to the lungs with every breath we breathe. Here, then, we have 
a beautiful and complicated piece of mechanism, in which the purifi- 
cation of the blood is effected, and the power of which for producing 



32 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

at will a current of air through the lungs makes the utterance of 
vocal sounds easy. 

The lungs of an infant before birth are dark red, and contracted 
into a small space, within the cavity of the chest. They are firm 
and specifically heavier than water, in which therefore they sink, 
whether entire or cut into pieces ; they also give out little or no 
blood, and no air-bubbles arise from them ; this, therefore, is consid- 
ered a good test whether a newly-born infant found dead, under sus- 
picious circumstances, was really born so ; if it has ever breathed, 
the lungs will have become inflated, so as to float on water ; they 
will then be of a pale-red color, and appear of a loose, spongy tex- 
ture, having expanded, too, so as to fill the cavity of the chest, and 
cover the heart, as we see them in the diagram of that organ above 

referred to. 

ARTERIES. 

These are the vessels which convey the blood from the heart. 
They were formerly supposed, from their being found empty after 
death, to contain only air, and hence the name. The arterial sys- 
tem of the human frame is that which performs one of the most im- 
portant functions on which vitality depends; proceeding directly 
from the heart, and ramifying in every direction, through all the va- 
rious tissues of the body, it conveys the blood, after it has received a 
supply of oxygen from the lungs, and been passed into the great 
organ with which the arteries are connected, wheresoever it is 
required for the purposes of life. These arteries are membranous 
cylindrical tubes, composed of three coats, viz. : the external, which 
is firm and strong, formed of tissues which take a longitudinal or 
oblique direction ; the middle, or contractile coat, which is thick and 
laminated, that is, composed of laminae, scales, or plates, arranged in 
layers ; and the internal coat, which is the thinnest of the three, and 
is easily broken in a transverse direction. From this we learn that 
the arteries are so constructed as to be capable of considerable ex- 
tension, and likewise of bearing a great amount of strain and press- 
ure, to which they are occasionally subjected, and which yet results 
sometimes in a rupture. 

. The whole of the arteries of what is called the systemic circulation 
proceed from a single trunk termed the aorta. This main trunk, 
or channel, proceeds from the left ventricle of the heart, and con- 
tains the pure arterial blood, known by its bright-red color, and 
issuing, when it makes its escape at any accidental opening, in jets, 
in accordance with the pulsations. From these the smaller arteries 
are given off as branches, dividing and subdividing to their ultimate 
ramifications, constituting the great arterial tree. 



veins. 33 

The arteries do not, as was at one time supposed, run immedi- 
ately into the veins, but are connected with them by what are 
called the capillaries, a hair-like net-work of vessels so minute that it 
requires a microscope to make them out. These are about 3 } Q - 
of an inch in diameter, and they are distributed through every part 
of the body so thickly as to render it impossible to pass a small 
needle into the flesh without wounding several of them ; hence, the 
flow of blood from a prick. It is through this medium that all the 
phenomena of nutrition and secretion are performed ; they are all 
small alike, and are joined on the one hand with the terminal ramifi- 
cations of the arteries, and on the other with the minute radicles of 
the veins, which see. 

The capillary vessels have but one coat, which is transparent and 
fibreless ; as they approach the arteries and veins, this coat becomes 
thicker, and, in accordance' with the substance thereof, they are dis- 
tinguished as fine or coarse ; the latter, gradually augmenting in 
size and complexity of structure, become what are called transitional 
vessels. 

VEINS. 

These are the vessels which return the blood to the auricles of 
the heart, after it has been circulated by the arteries through the 
various tissues of the body. They are much thinner in substance 
than the arteries, so that, when emptied of their blood, they are flat- 
tened and collapsed. 

Veins, like arteries, are composed of three coats : external, mid- 
dle, and internal. The external coat is the thickest, increasing in de- 
gree from the smallest to the largest one, the former gradually 
diminishing until it is lost altogether, and nothing remains' but the 
one coat in the capillary. In the middle, or contractile coat, which 
is thinner but finer than the outer, the chief remarkable feature is 
the presence of longitudinal as well as transverse fibres, the former 
consisting of closely-reticulated elastic tissue, occurring in layers, 
and alternating with the circular layers, composed of smooth, mus- 
cular fibres, interspersed with areolar tissue, and fine elastic fibres. 
The internal coat, stronger than that of the arteries, is composed of 
an epithelium and an elastic membrane, between which is situated a 
striated nuclear lamella. 

These membranes and tissues undergo considerable changes and 
modifications, in accordance with the size and necessary strength of 
the veins, which more frequently communicate with each other than 
do the arteries; these unions are called inosculations, and their 
object is evidently to obviate the obstructions to which veins are 



34 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

particularly liable, from the thinness of their coats, and their in- 
ability to overcome much impediment by the force of their cur- 
rent. 

One very remarkable feature of veins is their numerous valves, 
which are composed of a thin stratum of nucleated areolar tissue 
mingled with fine elastic fibres, and coated on the two surfaces with 
fine elongated cells ; the segments, or flaps, of these valves are 
semilunar in form, and arranged in pairs, one on either side of the 
vessel generally, but sometimes there is a single flap which has a 
spiral direction, and occasionally there are three. The free border 
of the valvular flaps is concave, and directed forward, so that, while 
the current of blood is permitted to flow freely toward the heart, 
the valves are distended and the current intercepted, if the stream, 
from fulness of the veins above, or other causes, should turn back. 
When we consider that the course of the venous current is upward, 
and so opposed to the law of gravitation, we see at once the fit- 
ness of such an arrangement. 



BRAIN. 

This is a collective term, signifying those parts of the nervous 
system, exclusive of the nerves themselves, which are contained 
within the cranium. The human brain, the average weight of 
which is three pounds in the male, and four or five ounces less in 
the female, is divided into three distinct parts, called the cerebrum, 
cerebellum, and medulla oblongata ; these several parts are invest- 
ed and protected by membranes. Of the membranous coverings 
which enclose that soft, pulpy, organic mass, two have been called 
mater (mother), from the old notion that they gave rise to all the 
other membranes of the body. These are the pia mater and dura ma- 
ter : the former is a very delicate tissue, covered in every part with 
minute blood-vessels, which are, in fact, the nutrient arteries of the 
brain, before entering which they divide and subdivide upon the 
external surface to an extreme degree of minuteness, so as to pre- 
vent the blood entering upon the tender cerebral substance in too 
forcible a manner. The dura mater is a much stronger and coarser 
membrane, which lines the inner portion of the skull, and forms an 
external covering for the brain and its appendages. It gives off 
several elongations, which are called processes, and which descend 
between certain portions of the brain : that termed the superior 
longitudinal process is the most remarkable, on account of its size ; it 
extends from the fore to the back part of the skull, between the lat- 
eral halves of the brain, and has been called falx cerebri in reference 



BONE. 35 

to its scythe-like form. The nervous mass constituting the brain is 
symmetrical ; that is, its parts are so arranged that, if we suppose 
the organ to be divided into two lateral halves by a plane passing 
perpendicularly through the centre, the parts placed on each side of 
this plane have a perfect correspondence with each other, and form 
in fact reduplications of each other. The principal parts of the cere- 
bral mass are thus double, but they are all united in the median line, 
with their halves of the opposite side. This union is effected by 
medullary bands of various sizes, and fissures, which pass from one 
to the other, called commissures. There are also ventricles, by 
which the cerebral parts are separated from each other at certain 
places ; four of them are commonly enumerated ; they communicate 
with each other ; the two largest are termed lateral ventricles ; they 
pass into the interior of the cerebellum. 

Under the microscope, the cerebral substance is found to be 
composed of pulp, containing both cells and tubes ; the outer por- 
tion of it is termed cortical, from cortex, bark, because it forms, as it 
were, the first coat of the mass. Larger in quantity, and firmer in 
consistence, is the inner substance, termed white or medullary. In 
man, the brain is much larger than is that of the inferior animals ; 
that of an ox scarcely weighs a pound. It is in the human brain 
chiefly that those great inequalities of surface exist — those " devel- 
opments," on which phrenologists build their theories ; they are not 
found in the hare or rabbit, nor in the Rodentia generally ; they are 
neither so bold, nor so deep, in the ox as in the horse, nor so much 
so in the horse as in the dog. 

BONE. 

This is the substance of which the framework of the animal 
body is composed, to which are attached the softer portions, which 
it alike protects and supports ; it is hard and firm, and therefore 
well adapted for these purposes, and also for affording leverage for 
the action of the muscles. Bone is a highly-organized and complex 
substance ; it consists of animal, and earthy, and saline materials, in 
the proportion of about one-third of the former to two-thirds of the 
latter ; or, to speak more strictly, according to chemical analysis, we 
may say that, in 100.00 parts, there are 33.30 of cartilage and blood- 
vessels, 51.04 phosphate of lime, 11.30 carbonate of lime, 2.00 fluate 
of lime, 2.36 magnesia and soda. 

In the human frame there are 252 bones ; they are of various 
forms and degrees of density or hardness : thus, in the limbs, they 
are hollow cylinders, combining lightness with strength ; in the 
body and head, they are chiefly flattened and arched, forming cases 



36 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

for the internal viscera ; in the spine and extremities, they are in 
many pieces, to facilitate the bending of the numerous joints ; their 
connections with each other are accomplished and preserved in 
many ways. In all bones, whether hollow or solid, the outer por- 
tion is harder than the inner ; many of them are spongy ; most of 
them have minute irregular cells scattered through their texture ; 
they are covered by a thin fibrous membrane called the periosteum, 
or, on the head, pericranium; inside the skull, this covering is 
termed dura mater (lateral). At those extremities where a smooth 
and elastic substance is required for the joints, most bones have a 
covering of cartilage. Bones are first developed in a gelatinous 
form, which hardens into cartilage, and then receives the deposit 
of lime, by which they are rendered firm; sometimes there is a 
deficiency of the earthy deposit, and thus the bones are bent and 
yielding, as in rickets. When there is too much lime, the bones 
are too brittle and easily broken. 

The bony frame, or skeleton, is formed by a complete assemblage 
of conjoined parts, the exact number of which is somewhat varia- 
ble, some few bones not being always present, and some minor ones, 
such as those of the ear, being often omitted in reckoning ; 252 may 
be stated as about the number of distinct parts which go to make 
up this complex structure. 

Beautifully are the various parts of the structure fitted and 
adapted to each other, and to their several uses and motions, act- 
ing by means of muscles and ligatures in a manner at once simple 
and combined, full of the most exquisite contrivances for facilitat- 
ing the necessary operations of human life, affording such full pro- 
tection to the internal parts, and combining so evidently lightness 
with the strength necessary for this purpose. 

SPINE. 

As the great main channel of nervous sensation, and the principal 
support to the bony frame, this is one of the most important parts 
of the human structure ; it is sometimes called the vertebral column, 
being composed of a number of vertebrae, or short single bones, so 
named from their peculiar construction, the term coming from the 
Latin verto, I turn ; these bones turning upon each other in such a 
manner as to give flexibility to the spine, which is the first devel- 
oped portion of the skeleton in man, and the centre around which all 
the other parts are produced. In its earliest formation it is a simple 
cartilaginous cylinder, surrounding and protecting the primitive 
trace of the nervous system ; but, as it advances in growth and or- 



MUSCLES. 37 

ganization, it becomes divided into distinct pieces, which constitute 
vertebrae. 

These admit of division into true and false : the true vertebrae 
are twenty-four in number, and are classed according to the three 
regions of the trunk which they occupy, into cervical, dorsal, and 
lumbar, the first having seven, the second twelve, and the third five 
pieces. The false vertebrae consist of nine pieces united into two 
bones, called the sacrum and the coccyx, the first having five, and 
the last four pieces. 

The vertebral column, as a whole, represents two pyramids, ap- 
plied base to base, the upper being formed by all the vertebrae from 
the second cervical to the last lumbar, and the inferior by the sacrum 
and coccyx. 

Viewed from the side, this column presents several curves, the 
principal of which is . situated in the dorsal region, the concavity 
looking forward ; in the cervical and lumbar regions the column is 
convex in front ; in the pelvic an anterior concave curve is formed 
by the sacrum and coccyx ; a slight lateral curve also exists in the 
dorsal region, having its convexity toward the right side. 

Did the bodies of the vertebrae rest immediately upon each other, 
there would be a rigid column which could not be bent in any direc- 
tion without displacement of the bones ; but, to provide against this, 
they are separated from each other by very elastic " intervertebral 
cartilages " which yield to every motion of the body, and prevent 
that shock to the brain which must occur at every step taken, were 
not some such provision made. Then, again, the vertebrae thus beau- 
tifully fitted into each other, and resting upon soft, yielding cushions, 
are braced together by a series of ligaments of different kinds, which, 
while they allow of all necessary motion, yet restrain it from going 
too far. By means of these and the muscles, which are mostly at- 
tached in a longitudinal direction, and chiefly to the posterior por- 
tions of the vertebrae, the equilibrium of the spine and the motions 
of the body generally are effected. 

Each vertebra having a triangular opening corresponding in posi- 
tion with the rest, there runs through the whole of the column a 
canal, which is filled with the nerve substance and membranes, com- 
posing what is called the spinal cord, that communicates with the 
brain through an opening in the base of the skull. 

MUSCLES. 

These are the fleshy portions of the animal frame ; it is by means 
of the muscular fibres that its various motions are effected ; all flesh 



38 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

being, in fact, muscle devoted to this purpose. The muscles are 
bundles of fibres of a tubular structure. Muscle is composed of a 
number of parallel fibres placed side by side, and supported and held 
together by a delicate web of areolar tissue ; so that, if it were pos- 
sible to remove the muscular substance, we should have remaining a 
beautiful reticular framework, possessing the exact form and size of 
the muscle, without its color and solidity. Toward the extremity 
of the organ the muscular fibre ceases, and the fibrous structure be- 
comes aggregated and modified, so as to constitute those glistening 
fibres and cords by which the muscle is tied to the surface of bone, 
and which are called tendons. Almost every muscle of the body is 
connected with bone, either by tendinous fibres, or by an aggrega- 
tion of these fibres constituting a tendon; and the union is so firm, 
that, under extreme violence, the bone itself breaks rather than per- 
mit the separation of the tendon from its attachment. In the broad 
muscles the tendon is spread out so as to form an expansion called 
aponeurosis. 

Muscles present various .modifications in the arrangement of their 
fibres, in relation to their tendinous structure ; sometimes they are 
longitudinal and terminate at each extremity in tendon, the entire 
muscle being fusiform, or spindle-shaped ; in other situations they 
are disposed like the rays of a fan, converging to a tendinous point, 
and constituting a radiate muscle. Again* they are penniform, con- 
verging like the barbs of a feather to one side of a tendon, which 
runs the whole length of the muscle, or bi-penniform, converging to 
both sides of the tendon. In other muscles the fibres pass obliquely 
from the surface of a tendinous expansion spread out on one side to 
that of another spread out on the opposite side. "When composed 
of penniform or bi-penniform fasciculi, they are termed compound 
muscles. 

Muscle, as before stated, is composed of bundles of fibres enclosed 
in an investment or sheath of areolar membrane which is continuous 
with the framework of the muscular fibres, each bundle of which, 
termed a fasciculus, is composed of a number of smaller bundles, and 
these of single fibres, which, from their minute size, and independent 
appearance, have been called ultimate fibres ; although microscopic 
examination informs us that each one of these is itself a fasciculus 
made up of ultimate fibrils enclosed in an extremely-delicate sheath 
called the myolemma or sarcolemma. 

Of the ultimate muscular fibre there are two sorts in the animal 
economy, viz., that of voluntary or animal life, called striated mus- 
cle, and that of involuntary or organic life, termed smooth muscle : 
the former is known by its size, its uniformity of calibre, and espe- 



pelvis. 39 

cially by its transverse markings, which occur at minute and regular 
distances ; it also presents markings or striae in a longitudinal direc- 
tion, which indicate the existence of fibrillse within the sheath, or 
myolemma, which is thin, transparent, and elastic. The chief pecu- 
liar property of muscles is their contractibility, by virtue of which 
they are enabled to exert so great an influence in the mechanical 
structure of the animal frame ; every variety of form and arrange- 
ment which they present is found to correspond exactly with the es- 
pecial purpose which each has to fulfil ; and generally, as well as in- 
dividually, they aflbrd striking indications of the wisdom and skill 
of their divine contriver and maker. The absolute power exerted by 
a muscle in contracting is commonly much less than its efficient 
power, a great part of its force beingJost by its being inserted 
obliquely on the lever which it has t<? inbve ; or on the distance of 
the muscle from the centre of motion ; or on the resistance which 
other muscles and the adjacent tissues present, etc. But it is con- 
stantly found that, where power is lost, there is a corresponding gain 
of velocity, extent of motion, compactness of force, or convenience 
and readiness of action, to compensate for this loss. 



PELVIS. 

This is the part below the abdomen, containing the bladder and 
rectum, and in woman also the uterus. This important part of 
the human frame is an irregular structure of bone supporting the 
spine, and resting upon the thigh-bones, whose rounded heads fit 
into the cups, or cavities, of the pelvic bones, at the acetabula. The 
pelvis consists essentially of three distinct masses of bone ; two of 
these are the os innominata (nameless bones) ; they form together the 
sides and front of the pelvic cavity, being united behind by a trian- 
gular bone called the os sacrum, which fits like a wedge between the 
two side-bones of the structure. The side-bones, although in the 
adult united each in one piece, are in childhood divided into three, 
and, for convenience of description, anatomists retain these distinc- 
tive divisions through life. Here we have a bony structure at once 
light, compact, and strong, admirably adapted to sustain the weight 
of the body, and to protect the important organs lodged within its 
cavity. In the female, this cavity is more broad and ample, and the 
bones are more extended, to afford sufficient room for the growth of 
the foetus, and for its safe delivery. It is manifestly of the highest 
importance that, in women, the pelvic bones should be fully devel- 
oped. In some cases, from disease or other cause, it is not so, and 
the opening through which the child has to pass, and which is never 
4 



40 ANATOMICAL DESCRIPTION OF IMPORTANT ORGANS. 

more than barely large enough for the purpose, is so small as to ren- 
der its extrication in a living state impossible. 

THE THROAT 




LONGITUDINAL SECTION, SHOWING THE NASAL CAVITIES, THE M0T7TH, THEOAT, 
LARYNX, AND (ESOPHAGUS. 

A, mouth ; B, soft palate ; C, tongue ; D, tonsils ; E, epiglottis ; F, thyroid cartilage ; G, 
arytenoid cartilage ; H, I, superior and inferior vocal cords ; K, ventricle of the larynx ; L, 
larynx ; M, N, trachea ; O, oesophagus. 

Beautiful as is the arrangement of that composite apparatus, the 
mouth, throat, and nose, but few persons comprehend the relation- 
ship of its parts. In the diagram, it is shown how the cavity of the 
nose opens at one point into the throat, and also how the windpipe, 
or passage to the lungs, opens into the oesophagus, or passage to the 
Stomach. The epiglottis is the valve that shuts the windpipe, and, 
when food is passing down the oesophagus, this valve closes down to 
prevent the food passing into the passage to the lungs. This 
" swallowing the wrong way " does, however, sometimes occur, and 
it has caused death. An exact knowledge of the relationship of 
these parts is necessary in making local applications for diseases of 
the throat, in extracting foreign bodies from the throat, and in plug- 
ging the nasal cavity, to prevent haemorrhage. 



HYGIENE AND DIET. 



The rules to be observed for the preservation of health follow 
almost necessarily from the facts of physiology. 

THE AIE. 

In considering respiration, we see that its great object is to 
bring the blood, in given portions at a time, constantly in contact 
with the air, that it may be purified and renewed. Respiration, 
therefore, will fail in its object, if the air we breathe is not pure. 
~No person would, of his own will, dip filthy water from a puddle 
and drink it when he might as well have that from the clear spring 
near by. Men, women, and children, are generally scrupulous enough 
in this respect, because they can see the filth in the water. In the air, 
however, they cannot see the particles that render it impure ; and 
thus people who are squeamish in regard to cleanliness will con- 
stantly take into their lungs indefinite quantities of foul air — likely 
to do more harm than filthy water in the stomach. People are not 
killed by foul air at once, unless they are placed in such circum- 
stances that they inhale suddenly very large quantities. Physi- 
ologists in the lecture-rooms illustrate this by experiments on two 
pigeons. They place one under a glass jar containing a certain 
amount of air, into which they slowly send carbonic acid gas — the 
gas that most commonly poisons the air of crowded places. Taking 
it thus slowly, the pigeon stands it very well. He becomes drowsy, 
dull, stupid ; can scarcely keep his feet ; staggers, falls, but can be 
aroused. Another pigeon is now put from the fresh air into the 
same jar, and in two or three minutes falls dead ; and then, after 
the death of the second pigeon, the first is brought out, and, breath- 
ing the fresh air, revives. This little experiment is instructive as to 
the manner in which foul air acts. The second pigeon was over- 
whelmed by the sudden reception of the great quantity of foul air 



! 



42 HYGIENE AND DIET. 

in his lungs, as men are who descend into old wells. The first 
lived in air equally bad, because he had from the first taken the 
poison gradually, and in increasing portions, his system acquiring 
the power to endure it. This is the way in which poison acts upon 
men who spend several hours in crowded, badly-ventilated shops, 
theatres^ lecture-rooms, sleeping-rooms, or other similar places. 
Death does not always ensue, but there is nevertheless always a posi- 
tive injury to the system. Poison is as literally taken into the sys- 
tem in this way as it would be if swallowed in our coffee, and it 
does harm even if it does not kill. 

Oxygen, as found in fresh, pure air, being therefore more neces- 
sary to life than any article of food, we ought to be as eager always 
to supply it to the system; taking care to transact business, to 
study, and to sleep, in well-ventilated apartments ; and to watch 
the premonitory throbbing in the head that will tell us, nine times 
in ten, that the air we are breathing is impure. Air that does not 
overpower may yet give us a fever ; and the poison of typhoid 
fever is probably always taken in by breathing impure air. 

Ventilation in sleeping-rooms should be from below as well as 
above, for the worst of the impurities do not rise, but fall. Heated 
air, being lighter than cold, will rise and pass out at the upper part 
of a window ; but carbonic-acid gas, being heavier than air, will 
accumulate near the floor, and remain despite all changes that go 
on above it. 

Air thus becomes stagnant from the failure of a current. Under 
such circumstances, its composition is quickly changed, from various 
causes ; while, at the same time, it is loaded with dust and deleterious 
exhalations given out by the human body, even in health, or pro- 
duced from the decomposition of animal or vegetable substances. 
Every one who has entered a room, that has been completely shut 
up for even a few days, whether inhabited or not, must have been 
struck with the peculiar smell of the air in it, and experienced the 
disagreeable sensation caused by its admission into the lungs. The 
walls and furniture are soon covered with a damp mould ; every thing 
within the apartment of a perishable nature falls quickly into decay, 
and affords materials for the still further vitiation of the atmosphere. 
Many complain of the unpleasant smell and dampness of their 
houses, without suspecting for a moment that this is merely the 
result of defective ventilation. 

It is all-important, therefore, that the air from without should be 
allowed to enter freely into every part of a building, if not in a con- 
tinued current, at least at frequent intervals, so as fully to expel 
that previously existing in the several apartments. 



THE AIR. 43 

In the largest and best-constructed houses, ventilation should be 
promoted, by leaving the doors and windows open several hours, 
during the day, in fair weather and when the air is driest, and clos- 
ing them carefully before nightfall. Even in winter, a proper 
opportunity should be taken, during the day, to admit freely the 
external air in every apartment of the house, especially the bed- 
rooms. 

In treating the hygiene of respiration there is a point of peculiar 
nicety that it seems necessary to determine — that, namely, in regard 
to exposure to the night ah*. On one hand, the inquirer meets the 
quasi medical dogma that the night air is hurtful ; on the other 
hand he is urged not to sleep in apartments to which the air has 
not free access. If he is to suffer from sleeping in apartments into 
which the air does not come, and to suffer also from the air when 
it comes, what shall he do ? 

None are more vigorous than they who live in the open air 
night and day, and no sleep is lighter, quieter, or more refreshing, 
than that taken with only the stars above us. This is not, that only 
robust persons sleep in the open air ; but sleepers in the open air 
become robust. This refers to all districts of country where the air 
is dry and pure, in a normal state. Have but little regard, there- 
fore, to those warnings against the air which represent it as an active 
poison so soon as the sunshine ceases to permeate it ; let it enter 
freely — always provided your house is not in a low, wet, marshy, 
malarious district. Doubtless the exaggerated fear of the night 
air originally came to us through the writings of the Italian physi- 
cians. So much and so justly dreaded is the evening dew in Italy, 
and particularly in the neighborhood of Rome, where the Pontine 
marshes constitute an immense laboratory for the production of 
malaria, that the inhabitants shut themselves up in their houses on 
the decline of day — never going abroad, unless compelled by abso- 
lute necessity, after sunset in the evening, nor before sunrise in the 
morning. 

Instances have indeed occurred, of individuals lying down to 
sleep at night in the Campagna, near Rome, and being found dead 
in the morning. Very few, at least, escape an attack of disease who 
have the imprudence to fall asleep exposed to the open air in an un- 
healthy district. Thus, history records many examples of the finest 
armies being destroyed, and the progress of the conqueror com- 
pletely arrested, by encamping for a single night, without sufficient 
shelter, in such a situation. The same precaution to avoid the damp 
and coolness of the night, experience has taught to every people 
who reside in situations where intermittent fevers prevail, or in 



£4: HYGIENE AND DIET. 

warm and tropical regions, where the heat of the day is sufficient to 
develop the dreaded malaria, by which the bilious, yellow, and 
other malignant fevers are produced. 

But this is a fear that does not apply in our healthy cities, or in 
the cool, clear air of the North generally. It should be noted, how- 
ever, that the great difference in temperature, between night and 
day, requires some care, in regard to exposure to sudden chill dur- 
ing the night — a common cause of one kind of diarrhoea. 



FOOD 

There are but few rules in regard to food that are positive. 
Each system is apt to have its vagaries, and its own laws, aside 
from the broad facts laid down elsewhere. There should be a judi- 
cious proportion observed between articles containing the several 
nutritive elements. Starch is in all the grains we eat, and in the 
potato — albumen in all fish and flesh, and oil in these and vegeta- 
bles also. Primarily all the nutritive substances are contained in ve- 
getables, and life is sustained by these alone ; but, to support the 
system of an active or laboring-man on a vegetable diet, requires 
too much labor from the stomach and digestive organs, and gen- 
erally weakens them. Systems sustained in this way are less capa- 
ble of endurance in any of the emergencies of life. This plan will 
answer with many, but not at large for the working-day world, 
Philosophically we may regard meat as vegetable food, in which 
two-thirds of the process of digestion is done before it reaches our 
stomachs. In the flesh of the bullock, or sheep, we may find, packed 
close and prepared for our use, all the nutriment that is in grass or 
grain ; and thus as the muscles of the ox save the muscles of man 
in the labor of the field, so his vast stomach saves the stomach of 
man in the labor of digestion, which is quite as much a part of the 
great labor of life as the other. Cookery, it has been justly said, in 
loosening the texture, and softening the fibres of food, " spares the 
stomach a drudgery that can be more easily performed by a spit or 
a stew-pan." And the edible animals do us somewhat similar ser- 
vice. Yet we should be careful not to go to the extreme of using 
too great a proportion of animal food, with a view to sparing the 
stomach. Meat is a stimulating diet, and the too free use of it 
forces the vital processes — induces and keeps up a sort of exalted 
vitality, that exhausts the system. Temperance in this regard 
should be especially observed by all those whose occupations are 
sedentary, or even not laborious. Farmers ploughing, or mowing, 
carpenters, blacksmiths, or any others, whose muscles are part of 



FOOD. 45 

the working machinery of society, can consume this concentrated 
fuel ; but merchants, bankers, clerks, lawyers, will best preserve the 
right condition of the organs by using meat much more moderately 
than is common. 

Beef and mutton are the best meats in use. They are more 
readily digested than any others, though there is a common notion 
that the flesh of the young animals, veal and lamb, because more 
tender under the teeth, must necessarily be more easily managed by 
the stomach. This is an error. Raw potato or cheese would seem 
more tender under the teeth — but the former article is scarcely di- 
gestible at all, and the latter is digested very slowly. Veal and 
lamb are softer because more gelatinous ; they are, therefore, also 
less nutritious and more difficult to digest. Invalids and dyspeptics 
should never use veal. Pork is a hearty, nutritious meat, difficult of 
digestion, an excellent diet for a laboring-man ; but they who have 
feeble stomachs should withstand the temptations of appetite, and 
use it sparingly. It should never in any circumstances be eaten 
raw, and in saying this we count smoked ham as raw meat. Ger- 
mans are very found of raw ham taken with bread for a sandwich, 
but sooner or latter this indulgence pays a heavy penalty, for the 
flesh of the hog is the refuge of parasites capable of development in 
the human system. One of these is the trichina, whose egg is laid 
in the flesh of the hog. If the flesh be thoroughly cooked before it 
is eaten, the egg is destroyed, but if it be eaten raw the egg develops 
a minute worm — and, existing in myriads, these cause a disease that 
results in death. Another reason against raw pork in any form is, 
that this meat contains the germ of the tape- worm. This is devel- 
oped, and thrives in the human intestine, if not destroyed by the 
heat used in cooking. 

Salted meat has a harder, tougher fibre, is less readily acted upon 
by the stomach, and furnishes a considerably smaller proportion of 
nutriment than a similar quantity of unsalted meat of the same ani- 
mal. 

Venison is an excellent meat, nutritious, and easy of digestion. 

The chicken is the best of the barn-yard fowls, and the turkey 
next ; goose and duck are heavy and oily. They make a palatable 
change of diet from time to time, but are not good for the regular 
or constant use of any but those with exceptionably vigorous stom- 
achs. 

Nearly all fish with white meat are delicate, digestible, and nutri- 
tious. The bass, the cod, the halibut, all the salt-water fish first ; next 
the fresh- water fish. Fish with red meat come after these ; eels ought 
to be excepted from the first class, and rated somewhat as pork 



46 HYGIENE AND DIET. 

among meats, and goose among fowls. Eels, however, may be so 
cooked as to extract the greater portion of the strong oil their 
bodies contain ; and, when this is done, the fine fibre and flavor of 
their flesh fit them for any table. It is said that in former times 
eels were practically submitted to the action of fire unskinned, and 
while yet alive, and that this process was very effective in with- 
drawing the oil through the skin. Fish are less hearty than meat, 
yet they are sufficiently hearty for even any purpose, as the vigor 
of the portions of population that live exclusively on them will 
testify. More readily digested than meat, yet serving satisfactorily 
the same purpose in the system, this food is a good substitute for 
continued use where necessary, or for simple variety of diet from 
day to day. 

In regard to shell-fish, there is no article comes to the table in 
which the idiosyncrasies of systems vary so much and are so much 
the governing law in regard to use. For those who can eat lobster, 
crabs, clams, oysters, they are good food ; they who cannot eat them 
will readily enough find it out, and must leave them alone. Lob- 
ster has a tough, hard fibre, and in many stomachs is not digested 
at all, as is sufficiently shown by the diarrhoea that always follows 
its use. Raw oysters, readily enough acted upon in most stom- 
achs, and, when so, a nutritious article, are absolutely poisonous to 
others. 

Broiling is the most favorable of all the ways in which meat is 
prepared for use. The immediate application of fire to the surface 
in this mode, by making a thin, hard crust, prevents the loss of the 
juices, and yet much less of the substance is rendered dry and tough 
in this way than in any other ; meat properly broiled, therefore, comes 
to the table sufficiently acted upon by heat, yet retaining all its 
flavor, its sapidity, and its nutriment. Other modes of cooking, 
while they give some advantage, involve some disadvantage. This 
alone meets all requirements. 

In frying, the heat is applied by means of fat, and thus the meat 
is in fact boiled in oil. All meats thus cooked taste alike, that is, 
they taste of the fat in which they have been boiled and generally 
burned. The peculiar flavor of the flesh is destroyed, and one of 
the best incitements to the stomach, the effect of the meat in the 
mouth as it acts on the organs of taste, is lost. Nothing can enable 
many stomachs to retain this meat, except the use of a large quan- 
tity of vegetable acid in pickles. This neutralizes the fat. But 
these pickles — the toughened fibre of a hard, green vegetable — are 
bad for any stomach. And thus one offence leads to another. 

Roasting is another excellent mode of preparing meat, but this 



FOOD. 47 

is generally confounded with baking. Roasting is cooking before the 
fire and in the air, the meat being held on a spit or other contri- 
vance that alternately turns one side or the other to the fire. 
This is analogous to broiling, and possesses nearly the same advan- 
tages. Baking is cooking in a confined space, as the oven of a range 
or stove, the heat not being applied directly to the meat, but to the 
walls of the enclosure. In this the true chemical changes of cook- 
ery that result from the direct application of the fire do not take 
place ; they are modified by the medium through which the heat 
passes, and the meat is rather dried than cooked by saturation 
with hot air. 

In boiling, the heat is applied by means of water, and much of 
the virtue of the meat is taken by this, as in making an infusion. If 
we make beef-tea, we extract all the better part of the meat by hot 
water, and throw the fibrous remainder away ; but, if we boil a leg 
of mutton, we subject it to nearly the same process, only at the end 
we throw away the watery extract, and eat the fibrous remnant that 
adheres to the bone. 

Vegetables fall readily into a natural classification of farinaceous 
substances, herbs, and esculent roots. In the first class are wheat, 
corn-meal, potatoes, rice, buckwheat, rye, oatmeal, barley, and 
dried beans and peas ; also arrowroot, sago, and tapioca ; in the sec- 
ond are all the vegetables that are cooked while green, or in the 
same state in which they grow, as spinach, cabbage, cauliflower, 
asparagus, green beans, green corn, green peas, and tomatoes. 
Properly we ought also to count in this class such green substances 
as the rhubarb, that is eaten stewed or in pies, celery, lettuce, 
pumpkin, squash, radish, onion, water-cress, and cucumber. In 
another class are carrots, parsnips, beets, turnips, and onions. 
Here, then, we have enumerated thirty different vegetable sub- 
stances, all in common use as food, an ample range for the stomach 
and the palate. 

Wheat, while more used than any other meal, is also the best. 
Made into such light, nutritious bread as is found in every house and 
nearly every baker's shop in the country, and eaten with butter, it 
makes in itself a satisfactory meal, one that does not pall the taste, 
and that will sustain life for an indefinite time. Corn-meal, buck- 
wheat, rice, and oat-meal, are only less excellent than this ; as corn 
and oat-meal are never ground so fine, they are irritating sometimes 
to intestines not quite healthy, but this quality also peculiarly fits 
them for the use of persons whose bowels are disposed to constipa- 
tion. Potatoes are not well digested in every stomach, and are in 
more common use than they deserve to be. 



48 HYGIENE AND DIET. 

The numerous articles classed under other heads should be 
taken as much as possible by all, the rule of choice being only to 
prefer such as are most agreeable to the taste of each person in the 
proper season. The full use of these, by varying the diet, and giv- 
ing the digestive organs employment they need, preserves health. 
This is more eminently true of the green herbs proper, as spinach 
and asparagus. No dinner, of those who can afford to eat what 
they choose, should be without tomatoes in the season when they 
become plentiful in the market ; green corn and cucumbers, and 
even the green beans of which the pods are eaten, are charged with 
many sins, and many also of which they are not guilty. We have 
nothing to say in defence of cucumbers. It is not pretended that 
they ought to be ripe when taken. It is therefore the prime fact of 
their presence on the table, that they must be green. Green vege- 
tables may be made good food by cookery ; but it is another necessity 
in regard to the cucumber that it must be eaten raw. This green, raw 
substance, therefore, goes' into the stomach in company with half 
a dozen substances which recognize that it is not safe there, and 
that the stomach must be fortified against it as against an enemy. 
Oil, to prevent the too ready absorption by the stomach of the half- 
poisonous acid juice of the plant ; vinegar to neutralize an excess of 
the oil ; and salt, pepper, and perhaps mustard, to hurry and even 
make possible the digestion of the luxury — cholera morbus may 
well result from such a compound. But corn and beans, though not 
actually ripe, are well cooked generally, and if well masticated will 
do no harm, unless gorged in unreasonable quantity. These sub- 
stances are usually so acceptable to the palate when first in season, 
that they cause the eater to forget all discretion, and the quantity 
taken often renders digestion impossible, and the overtaxed organs 
are relieved by a diarrhoea that generally comes on in about twelve 
hours. If the diarrhoea were induced by any specially-irritating char- 
acter of the articles, it would come on much earlier ; but, being due 
only to the failure to digest these substances, it comes on when they 
have passed from the stomach to the intestine, and lain there long 
enough to excite irritation. 

CONDIMENTS. 

There are persons who will not eat salt, not knowing, perhaps, 
that they take no article of food but contains this substance. Salt 
is a necessity, for animal life cannot be rightly sustained without 
it. In those who do not take salt, the intestinal canal can scarcely 
be kept free from worms. 

Other substances, classed as condiments, are in fact medicines, 



DRINKS. 49 

and their purpose is mostly to provide against the accidents of dys- 
pepsia. We take vegetable acid in the form of vinegar, as Europe- 
ans take sour wine to neutralize in the stomach oily substances ; 
and we take pepper and mustard as stimulants, to excite the sense 
of taste by their effect in the mouth, and to excite the languid, half- 
exhausted stomach to pour out gastric juice. 

Salt should always be taken ; vinegar should be taken to neutral- 
ize a dish too rich in fatty matters ; but hunger and health have 
no need of pepper or mustard. 

DRINKS. 

Water is a necessary part of all aliment, since it is quite as im- 
portant to keep up the supply for the fluid as for the solid parts of 
the body. We should remember that water is by weight in excess 
of all the other constituent parts of the body of any animal. Water 
taken at meals in moderate quantity, by increasing the fluidity of the 
contents of the digestive tube, favors absorption ; but water taken 
inmoderately at that time distends the stomach, rendering its 
action less effective, and dilutes the digestive juices. Thus it does 
harm. 

Water must be taken ; and it is in a great degree a question of 
the mind and palate, whether we shall take it pure or sophisticated 
with alcohol, sugar, and vegetable extracts — as in wine, brandy, 
beer, coffee, and tea. Taken pure, it answers every requirement in 
the healthy system ; and as a people we perhaps make more com- 
mon use of clear water than any other people equally civilized. In 
the many explanations of the peculiar energy and self-reliance of the 
American people > their qualities have been accounted for by our 
political institutions ; but they are probably quite as much due to 
this dietetic institution, the general use of clear water, and the con- 
sequently better average condition of the brain and nervous system 
of the whole mass of the people. If we should habitually use beer 
or light wine as do the English, German, French, and Italian people, 
we might, like them, acquire a flesh-making habit at the expense of 
blunting and dulling all that life of relation that depends upon a 
good state of the nervous system. 

"Alcoholic drinks," whether simply fermented and so taken with 
fruity juices, or whether distilled from those fermented liquors, 
have been regarded as a " savings-bank " in the system, because one 
of their more certain effects is to retard the waste. Assimilation 
thus goes on at the ordinary rate, waste does not go on so rapidly, 
and the system gains. But whoever uses alcoholic drinks to fulfil 
this indication will be the victim of a fallacy. In using such a sav- 



50 HYGIENE AND DIET. 

ings-bank, lie does not lay up good material ; he does not store away 
health and strength against the contingency of the future ; hut he 
keeps in the system matters that had better pass out ; he stores up 
that from which nothing but disease can be made. Gout, so com- 
paratively rare in the United States, is a national disease with the 
English, who live most on the above rule ; and gout comes to them 
logically, for its cause is a loss of proportion between what is taken 
into the system and what passes out. 

Whiskey, brandy, ale, beer, porter, and wine, are all useful in cer- 
tain states of the system, and are all injurious in their abuse. For a 
relaxed and feeble condition of the digestive organs, where constant 
stimulation would break the system down, the system would be the 
better for having the function of digestion performed under the influ- 
ence of a stimulus, and the best is a moderate quantity of Bordeaux, 
or other red wine, taken with the meal. In the absence of this, a 
very small portion of brandy or whiskey, taken in water, will accom- 
plish the same object. Malt liquors are peculiarly suitable to those 
conditions in which an immediately sedative effect is more desirable, 
as the narcotic is often quite as obvious as their stimulant effect. 
In an irritable state of the system, where irritability is not directly 
the result of great weakness, they are useful. Perhaps their pecu- 
liar advantage is entirely due to that which, with regard to the 
healthy body, is certainly an evil — their power to suspend the waste 
of the system. As they possess this quality in a double degree, in vir- 
tue both of their narcotic principle and their alcohol, they are the 
most effective of all liquors in causing that saving to the system 
which may be an advantage at times, but is not to be desired in 
general. 

In health, the first effect of this " saving " is an oppressive pleth- 
ora. Persons addicted to malt liquors increase enormously in bulk. 
They become loaded with fat ; their chins get double or triple, the 
eyes prominent, and the whole face bloated and stupid. Their circu- 
lation is clogged, while the pulse feels like a cord, and is full and 
laborious, but not quick. During sleep, their breathing is stertorous. 
Every thing indicates an excess of blood ; and, when a pound or two 
is taken away, immense relief is obtained. The blood, in such cases, 
is more dark and sizy than in others. In seven cases out of ten, 
malt-liquor drunkards die of apoplexy or palsy. If they escape this 
hazard, swollen liver or dropsy carries them off. The abdomen sel- 
dom loses its prominency, but the lower extremities get ultimately 
emaciated. Profuse bleedings frequently ensue from the nose, and 
save life, by emptying the blood-vessels of the brain. 

Pure water, says Dr. Hosack, is the beverage best calculated to 



DRINKS. 51 

promote health, to preserve the vigor of the intellect, and to secure 
long life. 

Coffee and tea are food. They owe their peculiar virtue to a 
body that, as found in coffee, is called caffeine, and in tea, theine ; 
but, though thus differently designated, the substance is the same in 
both. This substance, in its chemical composition, bears such a near 
relation to the material of which our nerves and brain are made, that 
scientific men have found in this the explanation of those revivify- 
ing and restorative powers that the experience of ages has found in 
these drinks. Coffee and tea, therefore, stimulate and excite the ner- 
vous system when it is quiet ; or, when it is reduced by fatigue, they 
strengthen and restore it, by the direct and immediate supply of 
material that has been lost by its too great activity. But tea is 
more obviously a sedative, and coffee a stimulant. How can this 
difference be accounted for, if their activity depends upon the same 
principle ? The difference is probably due to the presence of the 
other substances that give coffee its peculiar taste and aroma — es- 
sential oils : these, probably, communicate the peculiar stimulant 
quality. 

Tea is to be preferred for its greater simplicity — the tannin, that 
gives it astringency, being the only other substance of noticeable 
activity. Milk, as commonly used, diminishes the astringency of 
tea. Coffee, as sold ground at the grocer's, is seldom pure, and the 
common palate is now so vitiated with the stronger taste of these 
adulterations, that the decoction of the simple berry is thought to be 
poor in taste and thence in quality. 

Tea, taken four hours after the principal meal, will assist the 
latter stages of digestion, and afford the stomach a grateful stimulus 
after its labors. Uneasiness, however (from distention of the stom- 
ach), will result from taking it in too great quantity. 

Much of the appetite for wine and similar drinks is purely intel- 
lectual — the result of our constantly encountering their praises in the 
whole body of poetry in every tongue. 

In the time to come, when scholars shall make the people as fa- 
miliar with the songs of China as they now are with those of Italy 
and Greece, we shall have the same incitement toward tea ; mean- 
while, let tea-fanciers take comfort in such morsels as the following, 
written by the Chinese emperor, Kien Long, on a hunting excursion : 

" Set over a moderate fire a three-footed vessel, whose form and 
color indicate that it has been long in use ; fill it with clear water of 
melted snow ; let this be warmed to the degree at which fish grow 
white and the crab red ; pour this water into a cup upon delicate 
leaves of a choice kind of tea ; let it stand a while, till the first vapors 



52 HYGIENE AND DIET. 

which form a dense cloud have diminished, and only a slight cloud 
hovers over the surface. Drink then slowly this delicious beverage, 
and thou wilt become strong against the five cares which commonly 
disturb our spirits. The sweet calm which is obtained from a drink 
thus prepared may be tasted, felt, but not described." 

Fashion may fancy that nothing is more prosy than a teapot ; but 
it is ever the fashion to chant drinks that drive away care, and why 
not those that directly calm the spirit, as well as those that only in- 
duce forgetfulness of one perturbation by exciting another ? 



EXERCISE. 

Earn your dinner before you eat it — if not literally, by laboring 
manually for the money with which it is bought, yet in another 
sense, by taking enough exercise to excite that keen desire for ali- 
ment that will insure its digestion. As much attention should be 
given to getting an appetite as to getting food ; for, without one, the 
other is only an embarrassment. By all persons, whose duties do not 
involve active physical labor, exercise should be taken as regularly 
as food or sleep. Exercise must fulfil two indications: one with 
regard to the muscular system, one with regard to respiration. The 
wear of the muscles that sufficiently active exercise induces, is the 
most direct and proper incitement to the natural repair that keeps the 
system in a right state ; and the same activity, by forcing us to 
breathe more air, acts on the circulation as well as on the mass of 
the blood, and thus tends to make the changes of waste and assimi- 
lation more effective. Exercise should be taken in the open air, 
when possible, and that taken on foot is best for those whom it does 
not exhaust. Exercise on horseback is better than in a carriage, and 
in a boat, that the seeker of health rows for himself, better than all. 
But it should never become toilsome. Fatigue, if excessive, certainly 
is worse than no exercise. Exercise is not good at all times. If 
taken shortly before meals, it should be moderate. It is better that 
a meal should be preceded by a period of rest than of exertion. ISTo 
greater offence is committed against health than that of sitting down 
to eat worn out in body or mind, either by necessary labor or mis- 
taken recreation. Immediately after meals, rest ; and, in ordinary 
cases, let exertion not be very active for even two or three hours. 

For periect exercise, it is necessary that motion be communicated 
to every part susceptible of it ; that the breast be dilated beyond the 
usual bounds of rest ; that all the muscles attain the utmost degree 
of their extension and contraction ; that strength be exerted, and 
enjoy all its developments. The effects of such exercise, when not 



■H 



USE OF WATER. 53 

carried to the extent of producing undue fatigue, are to promote the 
circulation of the fluids throughout the body, to render the digestion 
of food more easy and perfect, to insure the nutrition of every part 
of the system, and to enable perspiration and the other excretions to 
take place with regularity. 

USE OF WATER. 

Cold water is a specific for half the ills that flesh is heir to ; not 
as used in the water-cure establishments, but as any person living 
comfortably may use it for himself. European physicians send near- 
ly all forms of chronic disease to the medicinal springs that are so 
abundant in Germany and France, and with the best results ; and 
apparently one sort of water cures as well as another, which has 
lately given rise to the notion that it is not the medicine in the 
water, but the water itself, that cures. Certainly the free use of 
water is alone very effective in many cases. 

Atticus, the friend of Cicero, while in that uncomfortable state 
of mind produced by disease of the stomach, became disgusted with 
life and resolved to destroy himself. He called together his rela- 
tions and friends, to communicate to them his design, and to con- 
sult with them upon the species of death he should choose. Agrip- 
pa, his son-in-law, not daring openly to oppose his resolution, per- 
suaded him to destroy himself by famine ; advising him, however, 
to make use of a little water to alleviate the sufferings which would 
at first result from entire abstinence. Atticus commenced this regi- 
men, while he conversed with his family, philosophized with his inti- 
mate friends, and passed many days in thus preparing himself for 
death. Death, however, did not occur ; on the contrary, by restrict- 
ing himself solely to water as his only nourishment, the pains of the 
stomach and bowels, by which he had been previously tormented, 
ceased ; and he speedily felt himself improved in health, and more 
tranquil in mind. Agrippa now attempted to convince him that, as 
the disease under which he had labored was happily removed, he 
ought to renounce his design of putting a period to his existence. 
Atticus confessed, at length, the justness of his son-in-law's argu- 
ment ; he accordingly followed his advice, and lived until a very ad- 
vanced age. 

But it is by bathing that we secure the best effects of water. 
The bath, whether warm or cold, is the most powerful of all agents 
that can be used for modifying the condition of the body. By re- 
moving from the surface all that would obstruct the pores, all adhe- 
sive excretion of perspiration, the bath fulfils its first requirement 



54 HYGIENE AND DIET. 

in keeping the skin in a state to properly perform its office, and 
carry out that large proportion of the waste that should go by this 
channel. Regular bathing, therefore, for this purpose only, is a pri- 
mary necessity. Without it, with the ordinary habits of life, and 
the clothing in use, the skin cannot be kept in order. We do not 
mean that it cannot be kept free from obvious disease, but that it 
cannot be kept in a state to perform its function. Either, therefore, 
other emunctories will be oppressed or the function will not be per- 
formed, the system suffering, whichever happens. Next to its use- 
fulness by purifying the surface, comes its efficiency in all the 
changes that result from the modification of temperature. In this 
way it is a most energetic stimulant to all the vital functions, respi- 
ration, circulation, and all the processes of digestion. Nothing is 
more potent as a remedy against all the forms of dyspepsia, than 
the regular use of cold water, in the daily bath, whether with the 
sponge, the shower, or by the plunge into a fresh, or much better, a 
salt water stream. Through all the more moderate seasons of the 
year, the cold bath should be used by those who have the necessary 
vigor to endure its stimulant operation ; but those whose systems 
are too enfeebled for this must use the tepid or warm bath. 

By a warm bath we are to understand that in which the tem- 
perature ranges from eighty-eight to ninety-eight degrees Fahr. 
This does not unduly heat or excite the body, but has a most sooth- 
ing and tranquillizing effect. The pulse, on immersion in it, is ren- 
dered slower, and the respiration more equable. If the heat be 
above ninety-eight, which is the temperature of the living animal 
body, or, as it is called, blood-heat, the bath becomes a hot one ; we 
may then look for accelerated pulse, flushed cheeks, and after a 
while a copious perspiration, bedewing the head and face. 

The most proper time for using the warm as well as every other 
kind of bath is, when the stomach is empty, and especially an hour 
or two before dinner. Many persons are deterred from having re- 
course to it, at this time, by the fear of their taking cold afterward, 
in consequence of exposure to the open air. The error here pro- 
ceeds from confounding the effects of over-heating and fatigue, after 
violent exercise, with those produced by the warm bath ; whereas 
they are totally dissimilar. In the former case, the skin is cold and 
weakened by excessive perspiration, and doubly liable to suffer from 
reduced atmospherical temperature. In the second, or immersion 
in warm water, the heat of the system is prevented from escaping, 
and has rather a tendency to accumulate, so that, in fact, the living 
body is, after coming out from this kind of bath, better prepared to 
resist cold than before. There is, in fact, no more occasion to dread 



SLEEP. 55 

catching cold, after having been in a warm bath, than from going 
into the open air, on a frosty morning, after leaving a warm bed. 



SLEEP. 

Cerebral and nervous power becomes exhausted ; the mind and 
the muscles of voluntary motion are unable to continue the exercise 
of their functions ; the muscles are no longer able to sustain the 
body erect; the head falls forward, the limbs relax, the spine is 
bent, and, unless supported, the man falls to the ground, or he previ- 
ously assumes the recumbent posture, that in which he is sustained 
with little or no exertion of the voluntary muscles. The mind 
meanwhile ceases from its labors, the faculties of judgment, and 
memory, and association, are one by one gradually suspended, and 
finally imagination, the last to quit, the first to return to its post, 
leaves it ; and the external senses, first sight (the eyelids have 
closed), then taste, then smell, then hearing, then touch, severally, 
and one by one, cease their exercise ; and — the man is asleep. 

The important fact to be kept in thought in regard to sleep is its 
periodical character. In health the cerebral and nervous power will 
give way at a period having a more or less definite relation to the 
time at which its daily activity began, as well as to the time at 
which it gave way on the day before. No doubt also the periodicity 
of the nervous system that controls in sleep has relation to the 
change from day to-night. It is, therefore, not only necessary that a 
certain number of hours should be given to sleep without regard to 
what hours in the twenty-four they may be, but they should be taken 
from that part of the twenty-four during whch the sun is below the 
horizon ; observance of the periodicity of the system is the rule for 
the hour at which sleep should begin, as well as the time for its con- 
tinuance. 

Excessive sleep weakens and torpifies the body, prostrates its 
powers, enervates and disorders its functions. Its effect on the 
mind is no less serious. It stupefies the sensibilities, blunts the 
feelings, warps the judgment, and impairs the memory. 

To secure sleep, the mind must be tranquil, its powers moderate- 
ly used, but not overworked, and its several faculties kept in proper 
subjection to one another; the muscles of voluntary motion must 
be exercised ; the stomach kept free from disturbance ; the circula- 
ting and respiratory organs, the functions of secretion and excre- 
tion, all perform their several duties without appreciable inconven- 
ience ; and the bedroom should be well ventilated and cool, the 
bed somewhat hard, the head well elevated, the feet kept warm, the 
5 



56 HYGIENE AND DIET. 

bedclothes sufficient to maintain the bodily heat without unduly- 
confining it. 

Every source of irritation of the intestinal canal which can op- 
erate during sleep should be avoided ; hence it is injudicious to take 
tonic or stimulant medicines at bedtime ; and, on the same princi- 
ple, purgative medicines should not be taken in the evening. Many 
individuals, however, are in the daily habit of taking a purgative 
pill at bedtime : but such persons always dream — a circumstance 
which never occurs in sound sleep. 

It is extremely difficult to estimate the quantity of sleep best 
adapted to preserve health ; much depends on the constitution of 
the individual, and as much on the nature of the sleep enjoyed. 

From six to eight hours' sleep may be regarded as the best pro- 
portion for a healthy adult ; and, undoubtedly, as much mischief 
may arise from too much as from too little sleep. If much sleep be 
indulged, the brain is brought into a condition unfavorable to its 
healthy functions, and favorable to apoplexy and coma; on the 
other hand, too little sleep, by wearing out the powers of the brain 
and the nervous system from protracted stimulus, may cause the 
same diseases. The indulgence of the propensity to extend the 
hours of sleep increases the desire for it. 



INDICATIONS AND DISTINCTIONS OF 
DISEASE. 



Health is that condition of the body in which all the functions 
of life are performed harmoniously, with ease, and with a feeling of 
well-being. Each organ acts without our consciousness ; the bodily 
energies play their part together ; and the union is so complete, that 
we neither feel nor care to inquire how the machine works. Every 
deviation from this state denotes, in strict language, if not the actu- 
al presence, at least the approach of disease. To observe with ac- 
curacy this deviation from health, and to be able to distinguish the 
particular tendency of the deviation, is the best skill of the physi- 
cian. By this sort of observation he ascertains from what disease 
the patient suffers, and this knowledge is the first step toward the 
use of remedies. Some of the commoner aids in the investigation 
of the problem, what is the disease actually before us, are pain, the 
pulse, the countenance, the state of the tongue, expectoration, etc. 

PAIN. 

Insensibility to pain would be by no means so great a boon as 
most of us would suppose, much as we might desire it ; physically, 
as well as morally, it is good for us to suffer ; for pain is a great 
teacher of salutary lessons as regards our welfare. We feel it in the 
head, or the chest, or the abdomen, or one or other of the limbs, 
and by it we are admonished that there is something wrong in our 
habits or mode of life ; that we have eaten or drunk too much, or 
of that which is unfit for us ; or indulged in excesses of some kind, 
or overtasked our powers ; or, it may be, not exerted or exercised 
them sufficiently : we have in some way impaired this or that part 
of our structure ; or there is some insidious disease eating into some 



^8 INDICATIONS AND DISTINCTIONS OF DISEASE. 

part of our system, and sapping our vital powers, the only indication 
of whose progress is the pain which it occasions. 

Sensibility to pain varies greatly in different individuals, and in 
accordance with the state and condition of the nervous system of 
the same patient ; it is most severe when the nerve itself is the seat 
of disease or injury, as in tic douloureux and other forms of neuralgia. 
Usually it is sympathetic, the nerves being only affected as the or- 
gans of sensation, through which all pain must necessarily be felt. 
Next to any affection of the nerves themselves, that of the bones 
and joints probably causes the greatest suffering, probably on ac- 
count of their unyielding .nature ; when swollen by disease they 
press upon the nerves, and so produce this result. Some parts 
which are most insensible in a state of health are most actively sen- 
sitive when they become inflamed : such is the case with some of 
the internal organs, and also with the bones, joints, and teeth. 

Pain in active inflammation, as well as in its hysterical simula- 
tions, is always present and prominent : it is pretty sure to be felt in 
congestion of any part ; in all malignant affections it is generally 
very acute ; in most kinds of fever it is complained of in the limbs 
and back ; in indigestion and dyspepsia we have it in the stomach, as 
we do also in colic and spasms of that part ; " a stitch in the side," 
as pain there is commonly called, may be owing to flatulency, and 
when it is in the chest, and increased by inspiration, there is reason 
to suspect an attack of pleurisy, or pneumonia, or a broken rib. 
Griping in the bowels may be due to colic, or to the presence of 
some acrid kind of food, or to inflammation of the peritonaeum, or to 
diarrhoea, dysentery, or cholera; throbbing pains in the temple, 
darting or shooting pains in the breast, flying pains about the 
shoulders and elsewhere, dull, heavy pains in the head, and a hun- 
dred other pains that could be named, are all characteristic of some 
particular form of disease ; although they do not all indicate the ex- 
act parts to which the disease is referable, they may be neryous sen- 
sations telling that mischief is going on somewhere, and calling on 
the sufferer to investigate the matter, and apply remedies. 

THE PULSE. 

The stroke or beat of an artery is simultaneous, or nearly so, 
with the contraction which takes place when the heart pours out a 
wave of blood through the arteries, the character of the pulsation 
being greatly influenced by the elasticity and muscular properties 
of these tubes. As the heart is the great central organ of circula- 
tion, and sympathizes with all the changes which take place in the 



THE PULSE. 59 

system at large, it follows that the pulse must be an important 
guide to those whose investigations are directed to the discovery of 
the ailments which cause functional and other derangements. But 
the information afforded by the beating of the pulse is only trust- 
worthy when it is carefully considered and weighed in connection 
with modifying circumstances. One ignorant of these might as 
well consult an oracle whose response to his questions is couched in 
unknown and enigmatical words, as the pulse. It follows, then, 
that a large amount of practical experience in the treatment of dis- 
ease is necessary to the proper understanding of this indicator of 
the state of the system ; the matter would be very simple if the 
mere frequency of the beats was an unvarying indication of this ; 
but, in many cases, the frequency is of far less importance than the 
rhythm, or tone. It may be full, bounding, or jerking ; soft, wiry, 
or compressible ; feeble, remittent, or intermittent ; and all these in 
a greater or less degree. 

True it is that, as a general rule, where there is a full, bounding 
pulse, measures of depletion may be safely adopted ; where there is 
a thin and feeble one, these would not be safe. This is about as far 
as the non-professional inquirer may venture ; it is well, however, 
for all persons who hold responsible situations, as heads of families, 
clergymen in country parishes, and especially such as are likely to 
go into partially-settled countries, where medical advice may be 
difficult of attainment, to make themselves as well acquainted as 
they can with the language, so to speak, of the pulse. The pulse 
may always be easily felt by the fore and middle fingers, pressed 
slightly on the upper and inner side of the wrist, about an inch above 
the lower joint of the thumb, where the pulsating artery lies, 
guarded by the strong tendon of the forearm. The beats may 
there be distinctly counted, and a little practice will render the 
detection of any irregularity or difference of force easy. With a 
healthy man in the prime of life, there will be about seventy-two 
beats in the minute, that is, supposing him to be quiet, and unex- 
cited. Any great bodily exertion, or mental emotion, will render 
the pulse more rapid. With children, where there is great activity 
both of body and mind, the arterial action will be accelerated. We 
give the above as a general average ; with some persons the beats 
rise to ninety in a minute, and even more, and with others they sink 
to fifty, and these variations are quite compatible with good health. 
Age has a great influence in the frequency of the pulse. The 
average will run near the following figures : At birth, 136 per min- 
ute; at five years old, 88 ; at from ten to fifteen years, 78 ; at, from 



60 INDICATIONS AND DISTINCTIONS OF DISEASE. 

fifteen to twenty-five years, 69 ; at from twenty-five to thirty years, 
71 ; at from thirty to fiffcy-six years, TO. 

THE TONGUE. 

The mucous membrane, as well as the form of the tongue, is 
liable to considerable changes in appearance, indicative of disordered 
states of the system. It is on this account that the tongue is so con- 
stantly examined by the medical man in diseases of the body. Its 
form and movements will often indicate the general state of the 
nervous and muscular systems ; while the appearance of the surface 
is an index to the condition of the mucous membranes throughout 
the whole body. Dryness, redness, smoothness, and the amount of 
white secretion on its surface, are all points from which important 
conclusions can be drawn, both with regard to the nature and treat- 
ment of disease. 

With regard to the disordered appearances of the tongue, we may 
note that it is sometimes loaded, as it is termed, the upper surface 
being covered with a layer of mucous substance, which may be 
scraped off with a tongue-scraper ; this indicates a foul stomach ; in 
severe cases of dyspepsia, this coating often becomes very thick and 
peels off, leaving the tongue red, moist, and tender ; sometimes the 
coating is dark brown, resembling fibres, which admit of being 
separated by the fingers ; it is then said to be furred, and this is 
symptomatic of great local irritation arising from inflammation. In 
feverish conditions of the system, the tongue becomes very dry and 
hot, parched, as it is called ; if clammy and viscid, there is usually 
derangement of the digestive functions ; a yellow tinge on the coat- 
ing of the tongue indicates biliary disorder ; a thin, creamy white, 
inflammatory disease in the abdomen ; in sore throat we often find 
it of a dingy, whitish color ; in scarlatina we have elongated pa- 
pillae, presenting bright-red spots, and, in some forms of intestinal 
irritation and haemorrhage, it is morbidly clean and red. In anaemic 
patients we find this organ partaking of the general condition of the 
system, being pale and flaccid ; in paralysis, it is drawn on one side ; 
in delirium tremens, and nervous affections, it is tremulous ; and, in 
low stages of fever, it becomes almost black, and cannot be pro- 
truded. Thus, to the instructed eye, the tongue affords a pretty sure 
indication of the state of the system, and is always consulted by the 
physician as a reliable authority. 

Before, however, such evidence can be properly weighed, an ac- 
quaintance with the normal condition of the organ is necessary ; 
some tongues are scarcely ever thickly coated under any circum- 



THE COUNTENANCE.— THE LIPS. 61 

stances, and others are scarcely ever clean, be the bodily health 
ever so good ; some are always dry, others always moist, and in 
shape and size they differ considerably in different individuals. 



THE COUNTENANCE. 

Tolerably clear indications of a person's state of health may gen- 
erally be read in the expression of the countenance ; where there is 
a great anxiety depicted on this dial-plate of the internal organs, 
there is likely to be functional or organic disease of the heart, pneu- 
monia, bronchitis, laryngitis, croup, consumption, dropsy of the 
chest, causing a sense of oppression and impeded respiration. In 
fevers, and other acute forms of disease, which shorten life, there is 
also this anxious expression, as well as in melancholia, hypochondri- 
asis, and to some extent in low forms of mania. 

When the countenance is livid and tinged with blood, there is im- 
peded respiration and circulation, probably congestion of the brain ; 
this is the case in apoplexy, disease of the heart, effusion of the 
lungs, etc. A pale countenance is a sign of fainting, of anaemia, and 
haemorrhage, external or internal. When the expression is violent 
and excited, there is probably the delirium of fever, inflammation of 
the brain, mania, or delirium tremens. In paralysis, convulsions, 
epilepsy, hysteria, and chorea, we have a distorted countenance ; 
and a flushed one is symptomatic of fever in general, and of the 
early stage of delirium tremens. Sometimes, in the latter stage of 
an incurable disease, the face becomes what nurses call " struck 
with death," and to this hopeless, corpse-like expression has been 
applied the term fades Hippocratica, because it has been vividly 
pictured by Hippocrates himself; here is his picture: "The fore- 
head wrinkled and dry, the eye sunken, the nose pointed, and 
bordered with a dark or violet circle ; the temples sunken, hollow, 
and retired ; the ears sticking up, the lips hanging down, the cheeks 
sunken, the chin wrinkled and hard, the color of the skin leaden or 
violet ; the hair of the nose and the eyelashes sprinkled with a yel- 
lowish-white dust." 

THE LIPS. 

By the color and general appearance of the lips, we may often 
judge with tolerably accuracy of the health of the individual ; if 
they be pale, and thin, and shrunken, there is a deficiency of the red 
globules in the blood, and a want of vigor in the circulation ; this 
we find to be the case in anaemia, and some other forms of disease. 
When the lips are full, and have more or less purple in their tint, 



62 INDICATIONS AND DISTINCTIONS OF DISEASE. 

we know that the blood does not undergo its proper changes, and 
that there is danger of congestion toward the brain. 

THE GUMS. 

The appearance of the gums frequently affords valuable informa- 
tion in investigating the nature of diseases : thus, when swollen and 
spongy, they indicate scurvy ; when there is a blue line along the 
edge, we may safely assume that lead has been absorbed into the 
system, either by drinking water passed through pipes of that 
metal, or by handling it in one or more of its forms and combina- 
tions, as painters are obliged to do ; a pink line indicates pulmo- 
nary consumption ; and when there is inflammation, with soreness 
and sponginess, accompanied by a deepening of the color, and a fetid 
breath, we may generally set it down to mercurial salivation. 

EXPECTORATION. 

By the nature of the expectoration it is often possible to 
judge of the character and progress of the malady with which we 
have to contend : if this be frothy, it indicates active bronchitis, 
catarrh, or influenza ; if stringy, and of a whitish or yellowish color, 
the bronchitis has become chronic or spasmodic, or there may be 
whooping-cough present or impending ; if purulent, it may indicate 
the latter stages of catarrh, or influenza, especially if the sputa, or 
matter spat up, is mixed more or less with a tenacious mucus ; 
genuine pus, capable of being poured from one vessel to another, in- 
dicates the bursting of a vomica on th} lungs, or of the matter 
of empyema, having found its way into the bronchial passages ; 
the yellow matter often expectorated in humoral asthma is not truly 
purulent, but to a large extent mucous. If lumpy, there can be no 
mistake as to the nature of the disease : pulmonary consumption 
has fairly set in, and made considerable advances ; there is sure to 
be a softening and breaking up of tubercles, where there are 
small yellowish or whitish lumps, expectorated along with the 
clearer fluid on which they float, perfectly distinct. If membra- 
nous, the sputa indicates inflammatory action of a chronic, most likely 
of a croupy character. If stringy and rusty-colored, there is cer- 
tainly pneumonia ; if bloody, there is haemoptysis ; either a blood- 
vessel on the lungs has broken, or blood has oozed out through the 
bronchial membrane, both symptoms of a very diseased state of the 
tissues, and indicative of great danger to the patient. If offensive 
and putrid, there may be gangrene of the lungs, but this is only a 
single sign, and not to be relied on alone. 



SCREAMING.— TABLE OF SYMPTOMS. 63 



SCREAMING. 

It is not uncommon for nervous and hysterical persons to manifest 
their uneasiness in this way ; and with children it is very usual, and 
it should not be allowed to pass without inquiry as to the cause ; if 
it is increased by any particular movement of the body, something 
connected with the dress may be the incitement, or some internal 
injury. When it is intermittent, some painful affection of the chest 
or stomach may be suspected. If it occurs during sleep, it may 
arise from the irritation of teething, or of worms, or from the presence 
of indigestible matter in the bowels, or from the impression of fear 
or terror, made on the mind by some fearful scene, or ghostly story. 
Incipient disease of the brain may also give rise to fits of scream- 
ing. Sometimes with children it is a mere habit which requires 
checking ; such, too, is the case not unfrequently with weak and 
foolish women, who encourage the habit. 

TABLE OF SYMPTOMS. 

The following table includes a sufficient number of the more 
evident abnormal conditions produced by disease ; used judiciously, 
it will prove an effective guide. It will be found that there are sev- 
eral diseases set down to each symptom, but this fact will cease to 
be discouraging, when it is remembered that every disease gives sev- 
eral symptoms, and that, running through several symptoms in this 
list, there are not many diseases under any one symptom that are 
found under two or three other symptoms. Make use of the table on 
this idea. Suppose the patient complains of headache : under that 
symptom ten possibilities are suggested — which disease is it ? It 
may be any one of these. Is there any other symptom to help us ? 
Determine which. Yes, there is drowsiness. Well, then it must be one 
of the diseases that are named in common under both those heads. 
This reduces the ten to five ; another symptom will reduce it still 
more. A distorted countenance will reduce the five to four. It is, 
then, one of the four diseases under that head. Thus, following symp- 
tom by symptom, reason to the knowledge of the disease. 

Headache: bilious disorders; hysteria; rheumatism; conges- 
tion of brain ; epilepsy ; apoplexy ; paralysis ; fevers, eruptive and 
other ; catarrh ; influenza ; constipation ; migraine, or simple neuralgia. 

Drowsiness and giddiness : congestion of brain ; epilepsy ; pa- 
ralysis ; bilious disorders ; indigestion ; fevers ; debility. 

Delirium, or incoherence : fevers ; inflammation of brain ; delir- 
ium tremens. 



64 INDICATIONS AND DESCRIPTIONS OF DISEASE 

Sleeplessness : indigestion ; delirium tremens ; fevers ; hypo- 
chondriasis ; hysteria. 

Eyes, bloodshot and watery : catarrh ; fevers ; inflammation of 
brain; measles; ophthalmia. 

Eyes, intolerant of light: strumous ophthalmia; inflammation 
of brain; fevers. 

Eyes, squinting : congestion of brain ; inflammation of brain. 

Eyes, smarting : ophthalmia. 

Eyes, contracted and dilated pupil : congestion of brain. 

Eyes, sallowness : bilious disorders ; fever. 

Eyes, yelloic : jaundice. 

Ears, noises in : accumulation of wax in the ears ; fever ; inflam- 
mation of brain ; hypochondriasis ; nervousness ; congestion of brain. 

Tongue, furred : disorders of stomach; disorders of liver ; indi- 
gestion ; catarrh ; influenza ; fevers. 

Tongue, black : typhus fever ; yellow fever. 

Tongue, scarlet : scarlet fever. 

Tongue, flabby, and notched at edges : debility. 

Tongue, sores on : thrush ; small-pox. 

Throat, sore : quinsy ; relaxed throat ; scarlatina. 

Throat, sioollen externally : mumps ; goitre ; quinsy. 

Hoarseness : croupy cough; croup ; catarrh ; hysteria. 

Countenance, anxious : hypochondriasis ; palpitation ; angina 
pectoris ; acute inflammations ; fevers ; dropsy of chest. 

Countenance, excited : fevers ; delirium ; inflammation of brain. 

Countenance, distorted: apoplexy; paralysis; epilepsy; hys- 
teria. 

Countenance, bloated and purple : apoplexy ; inflammation of 
lungs ; diseases of heart ; epileptic fits. 

Countenance, flushed: fever; delirium tremens ; inflammation. 

Countenance, pale : faintness ; hysterical fit ; paralysis ; haemor- 
rhage ; angina pectoris ; apoplexy in feeble constitution. 

Mouth, foaming at : epilepsy. 

Mouth, bleeding from : scurvy; purpura. 

Breathing, painful or hurried: inflammation of lungs ; pleurisy; 
consumption ; asthma ; dropsies ; whooping-cough ; child crowing ; 
croup ; fevers. 

Cough, and expectoration bloody : inflammation of lungs; con- 
sumption. 

Cough, frothy etc. : influenza ; catarrh ; asthma ; bronchitis ; 
fevers. 

Palpitation of the heart: indigestion; nervousness; hysteria; 
disease of heart. 



TABLE OF SYMPTOMS. 65 

Appetite, loss of: fevers; bilious disorder; debility; indiges- 
tion. 

Appetite, depraved : chlorosis; pregnancy; worms. 

Hiccough: indigestion; hysteria; debility. 

Nausea and vomiting : fevers ; indigestion ; hysteria ; hernia ; 
coUc; inflammation ; diarrhoea; cholera; gravel; eruptive fevers. 

Stomach, pain in : indigestion ; spasms ; small-pox ; inflamma- 
tion; colic; diarrhoea. 

Flatulence and griping : dyspepsia ; costiveness ; hysteria ; 
colic ; dysentery. 

Abdomen, distention of: dropsy ; flatulence ; constipation. 

Abdomen, tenderness on pressure : inflammation of bowels ; 
inflammation of liver ; inflammation of kidneys ; inflammation of 
womb ; inflammation of bladder ; retention of urine. 

Bowels, confined : bilious disorders ; colic ; inflammation of 
bowels ; hypochondriasis ; hysteria ; chlorosis. 

Urine, abundant and pale : hysteria ; nervousness. 

Urine, abundant and high-colored : diabetes. 

Urine, high-colored, with sediment, and scanty : dyspepsia ; bil- 
ious disorders ; jaundice ; fevers ; inflammations ; rheumatism ; 
gout ; scarlatina ; dropsies ; disorders of kidneys ; gravel, etc. 

Urine, bloody : inflammation of kidneys ; scarlatina. 

Skin, sweating and cold : angina pectoris ; hectic fever ; debility ; 
consumption. 

Shin, siceating and hot : rheumatism ; eruptive fevers. 

Shin, chilliness of: fever; catarrh; debility. 

Skin, hot and dry : fevers and inflammation. 

Pulse, rapid, full, and sharp : inflammations ; fevers ; rheuma- 
tism; gout. 

Pulse, rapid and small : debility ; typhus ; collapse ; hysteria ; 
debility ; nervousness. 

Shivering : catarrh ; influenza ; fevers ; inflammations. 

Limbs, pains in : catarrh ; influenza ; rheumatism ; gout ; 
fever. 

Limbs, cramps in : diarrhoea ; cholera ; convulsions ; hysteria. 

Limbs, loss of power in : debility ; typhus ; apoplexy ; paraly- 
sis; lead-poisoning; fainting; catalepsy. 

Limbs, swelling of ': dropsy; white leg; rheumatism; gout. 

Limbs, twitching of: fever; delirium tremens ; Saint Vitus's 
dance; hysteria. 



DISEASES OF THE GENERAL SYSTEM. 



FEVER IN GENERAL. 

Fever is a word that no one has yet satisfactorily defined, 
though the disease is one that any person readily recognizes. It is 
a disease that pervades the whole system, and deranges every func- 
tion' in a greater or less degree, but it has a tendency to localize 
itself and expend the greater amount of its force upon some one 
organ. In one fever, the head principally suffers ; in another, the 
chest, while a third may be rendered serious only in its effect upon 
the abdominal organs. As to the cause of this difference, it is prob- 
able that individual peculiarity has much to do with it. An organ 
rendered feeble by any means is the one that will suffer in the sys- 
tem; but there is something in the conditions that surround the 
patient at the time, and something in the essential'character of the 
disease. Typhus has been called cerebral fever, from the uniformity 
with which it assails the brain ; and typhoid, because of its difference 
in this regard, has been called abdominal. 

So far as observation and study have yet pursued fever, the first 
essential fact in its history is a poisoned condition of the blood. 
Poison floating in the atmosphere is taken in by respiration, passes 
from the lungs to the blood, and renders the blood unfit for its pur- 
poses. Its primary effect is seen in, the nervous system, in the chill, 
languor, and general uneasiness. Reaction follows, with bounding 
pulse, heat, high color, brilliant eyes — all the phenomena of ex- 
aggerated vitality, which, exhausting the system like overlabor, re- 
duces it to extreme debility. In proportion as the first onset was 
severe, and the nervous system more or less overwhelmed, so the 
reaction will have greater or less force, and the fever be what is 
called " sthenic," or not. Something here also depends upon the pecu 
liar character of the poison. If it is miasmatic poison — the poison that 



DISTINCTIONS IN CONTINUED FEVER. 67 

is formed by the action of the sun upon rotting vegetation, as in 
marshy or badly-drained districts — the resulting fever will be one 
of the class called palludal, the most common of which is fever and 
ague. If the poison be animal — the emanations from the human 
body, for instance, as they accumulate in crowded tenements or 
other badly-ventilated places — the fever will be typhus or typhoid. 

Fever, it should be observed, occurs in the course of nearly every 
other disease. It is then only a symptom of the deep disturbance 
of the system, and will disappear with the disappearance of the 
disease that brought it, though there are cases in which it becomes 
the more serious of the two. 

In fever, a poison oppresses the nervous system, and this oppres- 
sion, and the reaction from it, are the phenomena of fever ; but the 
nervous system is oppressed in other circumstances by cold, fatigue, 
deprivation, etc., and reacts from these also, and this group of de- 
rangements is febrile in character, but should not be confounded 
with essential fever. 

Essential fevers are classed as follows : Simple fever, typhus, 
typhoid, remittent, intermittent. 

DISTINCTIONS IN CONTINUED FEVER. 

Simple fever is that common disturbance of the system that accom- 
panies a cold, or results from overtaxing the faculties in any way. 
Typhus is the deep, prostrating fever that overwhelms the system, in 
which the patient is for days in delirium and unconscious of natural 
wants. Typhoid (the name meaning " like typhus ") is a less intense 
type of a disease that may practically be regarded as the same. All 
these fevers consist, in a general way, of the same derangements, 
differing mainly in severity. "Weariness, lassitude, an indisposition 
to any activity, mental or physical, is the first indication of illness 
in all fevers alike. Chill comes next, and this may be well marked, 
or it may be only a vague shivering, or peculiar sensibility to cold 
air. Increased heat of the skin, headache, pain in the back, rapid 
pulse, suffused face, thirst, general excitement, delirium, and debility, 
come in their course and make up the history of the disease. Such 
is the common outline of the class of continued fever, but there are 
special differences between these, and upon such differences the 
treatment must vary. 

TYPHUS AND TYPHOID FEVER. 

All fevers are alike at their onset. Nearly the same words 
would describe the earlier hours of the above-named fevers, of simple 



68 DISEASES OF THE GENERAL SYSTEM. 

fever, of remittent, of small-pox, or measles. Till such signs appear 
as indicate the particular form of disease that is present, it will be 
necessary to adopt the most general remedies, if any, to moderate 
the force of the onset. In such cases, it will always be safe to give 
a mild saline aperient, as the citrate of magnesia, and a diaphoretic, 
as a teaspoonful of Mindererus' spirit, once in two or three hours. 

Not only is it quite doubtful, at the commencement, what form 
fever will assume, but it is not always certain that disease assuming 
febrile character is fever. Pneumonia, pleurisy, and bronchitis, are 
all accompanied in their course with fever, and are often admitted 
into hospitals as fever cases. Bronchitis occurs commonly as part 
of typhoid and typhus fever, and this makes it the more necessary 
to discriminate whether a given case is fever with bronchitis or 
bronchitis with fever. Accurate inquiry will always determine, in 
the case of bronchitis, that cough was the first trouble. 

But to the general symptoms — to the uneasy and peculiar sensa- 
tion in the stomach, the nausea, and giddiness ; languor, lassitude, 
anxiety about the pit of the stomach, and region of the heart, alter- 
nate heats and chills, or a sense of creeping in different parts of the 
body — there will succeed, if the fever is to be typhus or typhoid, symp- 
toms of a more threatening character about the third or fourth day. 

The face will become suffused, will have a dusky, lurid look, and 
the color may vary from a simple dingy hue, to the shade of new 
mahogany. The eyes will be suffused also. 

The tongue will become brown, and from the third to the seventh 
day the secretion that kept the mouth moist will dry and blacken 
on the teeth, tongue, and lips. 

By the seventh day twitching will accompany every movement 
of the hands. 

There will appear over the chest, abdomen, arms, and legs, a 
blotchy eruption, rose-colored in typhoid, deeper in typhus. Each 
particular point of eruption will be very minute. But the eruption 
is not a constant sign, and is commonly overlooked altogether. 

In ten days, at the latest, sometimes from the commencement, 
there will be delirium, generally not active but of a low, mumbling, 
muttering character, and all the senses will be dull, hearing, espe- 
cially indistinct. Illusions of vision occur, and the patient seems to 
grasp at things seen. Passages from the bowels and from the blad- 
der may take place involuntarily. 

Pulse is one hundred or less, and becomes small and feeble. 

Dulness of the senses may pass to a state of entire insensibility. 

If the disease is typhoid, there will be diarrhoea, and probably 
- 'jleeding from the nose, in the first week. 



TYPHUS AND TYPHOID FEVER. 69 

More or less bronchitis will occur in the course of either fever. 
Abscesses may occur, and erysipelas. Sometimes the pulse is not 
much affected in the beginning, but, as the disease advances, it usu- 
ally becomes small, weak, frequent, and often irregular. 

Such are the prominent symptoms of an ordinary case. If it 
proceed toward a fatal termination, the symptoms of debility in- 
crease, and become extreme ; the patient lies prostrate on the back, 
with extended arms, and insensibly glides down to the bottom of 
the bed ; there is a continued state of insensibility ; a low, muttering 
delirium ; a peculiar yet indescribable expression of anguish in the 
countenance ; twitching of the tendons ; picking at the bedclothes ; 
involuntary evacuations, and hiccough. 

If the disease appear under the form of the severer or malignant 
typhus, frequently called putrid fever, its attack is more sudden and 
violent, its progress more rapid, and all the symptoms of debility 
appear earlier, and in an aggravated form. Here the rigors are ex- 
tremely severe, the heat of the skin often peculiarly acrid and burn- 
ing, the headache intensely painful, the expression of anguish in- 
describably acute, the pulse tense, hard, quick, and fluttering. The 
prostration appears early, and is extreme; the fever sensibly in- 
creases every evening ; the delirium is high and ferocious ; the com- 
plexion is brownish, the eyes are heavy, the breath hot and offen- 
sive. 

The duration may be from three to five weeks ; commonly the 
first improvement becomes apparent toward the end of the third 
week ; there is a moister tongue, a less dusky face, and a slower, 
fuller pulse. Patients who get better begin to complain that they 
feel worse, because they begin to be conscious how they feel. 

Both fevers are contagious, but typhoid only feebly so ; and both 
are also epidemic. Typhus is often propagated by contagion, and 
when a patient afflicted with typhus is confined in a damp, close, 
and stagnant atmosphere, deprived of free ventilation, and exposed 
to the noxious exhalations of accumulated dirt and filth, he is in a 
condition to communicate the disease in its worst form, and it is 
from such a source that the severer or putrid form of typhus com- 
monly arises. Indeed, this fever frequently arises in crowded places, 
among persons previously healthy, when due attention has not been 
paid to ventilation ; and in this way it often appears in jails, trans- 
port-ships, hospitals, and the crowded and filthy habitations of the 
poor. 



70 DISEASES OF THE GENERAL SYSTEM. 



PARTICULAR DISTINCTIONS BETWEEN TYPHOID AND TYPHUS FEYERS. 

Typhoid comes on more gradually than typhus. The aspect of 
the typhoid patient, though heavy, is less dusky than that of the 
typhus patient ; its expression is less dull and more anxious. Some- 
times, when delirium occurs, the typhoid patient is more active, 
and is more desirous of getting out of bed. 

Diarrhoea is a characteristic symptom of typhoid fever. Often 
it is an early symptom, but sometimes it occurs at the end of the 
first or beginning of the second week. It is spontaneous, or con- 
tinues after purgative medicines. Abdominal pain frequently pre- 
cedes or accompanies it. The stools are dark and fetid, or yel- 
low-ochreish. The abdomen on pressure is hard, and sometimes very 
much distended. Whether large or not, its convexity is from side 
to side, is tub-shaped, from gas in the intestine. Usually there is 
noticed in the first stage, but oftener in the more advanced stages, a 
slight gurgHng movement, from liquid and gas in the bowels, which 
movement is audible or palpable on pressure. This symptom is not 
common in other diseases ; it is rare in typhus fever. The character 
of the evacuations is almost distinctive of the disease ; thin, yellow- 
ish, ochrey. "When, in fever, such stools persist day after day, and 
several of them every day, you may safely infer that there is ulcer- 
ation of the bowels, though no pain of the abdomen should be com- 
plained of even on pressure. When hemorrhage from the bowels, 
which is apt to occur in this stage of the fever, takes place, it 
strengthens this inference. The haemorrhage often occurs unexpect- 
edly, sometimes in large quantities, rapidly exhausting the patient; 
or it recurs at intervals in smaller amounts, effectually though more 
slowly wasting his strength. The bleeding is probably owing, in 
general, to the division or opening of veins by ulceration. Some- 
times the blood enters the bowels, but is not voided. Haemorrhage 
from the bowels occurs in continued fever sometimes in connection 
with other putrid symptoms; petechiae, purple spots, bruise-like 
blotches, and extreme vital depression. This haemorrhage is a symp- 
tom of the worst omen. . As in scurvy and purpura, it depends on a 
morbid state of the blood, which, when drawn, loses its natural ten- 
dency to coagulate. This particular character of haemorrhage be- 
longs rather to typhus fever. 

Eruption of Typhoid Fever. — This is very different from that of 
typhus fever. It consists of little circular, bright rose-colored, 
slightly-elevated spots, with round heads, which fade insensibly into 
the hue of the neighboring skin. These spots disappear.,completely 
under pressure. Each lasts about three days. Others follow. Or- 



DISTINCTIONS BETWEEN TYPHOID AND TYPHUS FEVERS. 71 

dinarily from six to twenty-one present at one time ; occasionally 
one only ; sometimes more than a hundred. These spots begin to 
disappear generally in the second week, and fresh ones come out 
every day or two till the third week, when they cease to appear, ex- 
cept in case of relapse, when they may recur. These spots do not 
remain visible on the dead body. Flea-bites, which might be mis- 
taken for typhoid spots, are round red stains with dark central 
points. The tongue is oftener moist throughout typhoid than typhus 
fever, and when dry more frequently red, and as it were glazed. 
Generally, if brown at all, it is of a yellowish instead of a blackish 
brown. 

Treatment. — Make no effort to cure the disease. It is not cu- 
rable, that is, it cannot be cut short by treatment ; but it has a dis- 
tinct limit, and when it has run its course the patient will get well 
in the majority of cases. All that treatment can do is, to give each 
particular case the best chance it has to get well. Because the dis- 
ease is not one that active treatment can at once break up, it is not 
to be supposed that treatment is useless. On the contrary, there is 
hardly a disease in which careful treatment does more to save life. 
It is the object of treatment to keep the man alive, while the dis- 
ease runs its course, and to prevent his falling a victim to what we 
may call the accidents of the disease. Patients in this fever, says 
a distinguished physician, who spend three nights in restless delir- 
ium, almost invariably die. Proper treatment can prevent a patient 
from passing three such nights, and thus save his life ; this is an 
illustration of its office in these cases. 

Combat the poison of the disease by medicines likely to improve 
the state of the blood ; assist as you may the excretion of the poi- 
son by the kidneys, skin, and bowels ; treat dangerous symptoms as 
they arise ; put the patient in the best hygienic conditions possible 
in the circumstances ; exhaust ingenuity in the administration of 
liquid food, and at the last, if necessary, keep the vital machinery 
in operation by stimulants ; never give up. Remember that the 
machinery is not worn out, only oppressed by a poisoned blood ; 
it can be driven by alcohol, and life may be saved by keeping the 
action up an hour longer. 

Give at the commencement some mild aperient medicine, to be 
sure that the intestines are not loaded — castor-oil, in a dose pro- 
portioned to the case, from a drachm to an ounce ; or a seidlitz pow- 
der, made more active by the addition of a small quantity of epsom 
salts. Have the surface well washed with sponge and water. For 
the first period, give in addition to this only a mixture of ammonia, 
either the liquor of acetate of ammonia, a teaspoonful once in two 
6 



72 DISEASES OF THE GENERAL SYSTEM. 

hours or the carbonate of ammonia mixed with water, in the pro- 
portion of one grain of ammonia to a teaspoonful of water, of which 
mixture give a teaspoonful once in two hours. Take care that the 
patient is placed in such situation that the air from without can 
have free access to the room. This is without regard to season. In 
the winter have plenty of fire in the room, have blankets in any 
necessary quantity, but have the fresh air. Let the food be beef-tea ; 
solid food will do harm, because it cannot be digested, and irritates 
the diseased intestine; mixtures of the various farinaceous sub- 
stances may be given, arrow-root or farina ; broths of vegetable 
juices, as the juice of the tomato, and fruits in their season, with 
one or two ounces of wine a day, in persons accustomed to the use of 
liquor. Ordinary cases thus treated will go through very well with 
no other medicine than the ammonia mixture. 

Severer cases will require more active treatment in many re- 
spects ; but all should at the commencement be treated as above. 
In typhoid there will be diarrhoea, and therefore it will not be neces« 
sary to give any additional opening medicine ; but make no effort 
to arrest the diarrhoea ; it is the result of disease in the intestines, and 
the retention of the discharged matters, by the irritation it would 
cause, would make that disease worse. Great febrile heat may be 
consequent upon the state of the intestines and stomach, and this 
may, early in the disease, require a small dose of calomel, five grains, 
to be followed by an aperient. Where there is no diarrhoea, the 
bowels may require attention, but no cathartic medicine must be 
given where the weakness is particularly notable. 

Where the symptoms of disturbance of the brain are persistent, 
and come on early ; where there is high delirium, excessive restless- 
ness, and especially where the breathing is not regular, the proper 
interval of respiration being lost, and a deep breath being then taken, 
as if to make up, there is great danger. In these cases the hair 
must be cut, as it may in any, since it will eventually fall ; and the 
head cooled by evaporating lotions, or by the affusion of cold water. 
If the patient does not complain of headache after his delirium 
comes on, the lotions and the affusion will often ameliorate the head- 
symptoms ; but, if the headache persists, the case is more severe, and 
lotions will be of little use. But pouring cold water on the head 
has been found a very effective remedy in these cases. In these 
cases, if the affusion is inconvenient or ineffective, use the following 
mixture : 

Tartrate of antimony and potassa, .... 3 grains. 

Tincture of opium, 2 drachms. 

Mucilage, 1 ounce. 

Water, 5 ounces. 



SIMPLE FEVERS-ITS FEATURES AND TREATMENT. 73 

Let an adult take a tablespoonful of this every hour, till the 
head-symptoms are relieved, and then it should be taken four or 
five times in the twenty-four hours. 

In a case in which the abdominal symptoms are severe, if there 
are delirium and wakefulness, give ten grains of Dover's powder at 
night. 

Distention of the abdomen with gas will often greatly aggravate 
the discomfort. It may be relieved by the application of hot fo- 
mentations. If these are ineffective, a skilful person may pass a 
rectum-tube, but with the greatest possible care. 

Guard against bed-sores in a protracted case, as these can be 
easier prevented than remedied. 

The question of the use of whiskey, brandy, or wine, in fever, is 
one of the highest importance. Physicians have endeavored to lay 
down precise rules, drawn from the state of the patient, for the use 
of these, but without satisfactory results. The effect on the patient 
is the final test. Try a moderate dose at an advanced period of the 
disease, when the danger is that the patient's strength will not 
carry him through. If the restlessness becomes less, if it moderates 
delirium, if the pulse that was frequent and small becomes fuller 
and slower, keep on. Give either brandy or whiskey, in half- 
ounce doses, once in two hours, or once in four hours ; only the 
actual trial can properly regulate the time or dose. Keep on while 
the amendment is evident. If, on the other hand, the first or second 
trial of the dose does no good ; or if, as sometimes happens, every 
thing at once looks worse, stop it* 

SIMPLE FEVER— ITS SPECIAL FEATURES AND TREATMENT. 

Simple, continued fever is very likely to be mistaken for typhoid, 
or a typhoid fever at its commencement for this ; it is only in the 
short course of the milder disease, and in its ready and spontaneous 
cure, that people generally can first see the difference. Then they 
know it is not typhoid. It is this disease that doctors have had 
dealings with in cases in which they have claimed to have cured 
typhoid fever. 

Simple fever is to be known by the presence of the following 
symptoms : 

1. The heat of the skin is greater than natural. 

2. The pulse is unnaturally frequent. 

3. There is some thirst. 

4. Furred tongue. 

5. Loss of appetite. 



74 DISEASES OF THE GENERAL SYSTEM. 

6. Some change in the stools, in the urine, or in both. 
V. Some languor of body and lassitude of mind. 

Any of these symptoms may occur in other diseases, but their 
concurrence, and the absence of any other of note, constitute simple 
fever. All the symptoms are more marked, as a rule, toward night. 
Seven days is the ordinary duration of this disease, and it does not 
endanger life. 

Treatment. — Keep the patient quiet and in bed, not too heavily 
covered, and in a room of mild temperature, which can be very 
freely ventilated at regular intervals ; for pure air is essential to 
speedy recovery. Give at the commencement, if there is any 
nausea, a mild emetic, say, for an adult, powder of ipecac, twenty 
grains. If the heat of the skin be great, give a sponge-bath, wash- 
ing the body of the patient all over, either with pure water or water 
to which some alcohol has been added. Some light laxative must 
be given within the first few days, as the bowels are costive, or the 
stools offensive. In the latter case give 

Hydrargyrum cum creta , 3 grains, 

Powdered rhubarb 8 grains, 

to be followed, in four or five hours, by half an ounce of castor-oil. 
Cold water is the best drink ; it may be made slightly acid by the 
addition of a little lemon-juice, or currant-juice, or jelly. Give 
spiritus Mindereri, a tablespoonful once in four hours. 

No food should be given, but light broth, gruel, or beef-tea. 

GASTRIC SYMPTOMS (Status Gastricus). 

There is a form of simple fever that seems to be caused entirely 
by derangements of the stomach, and which, generally passing off 
with a fit of vomiting and some consequent prostration, now and 
then assumes a graver character. Sometimes it results from ex- 
cesses in eating and drinking, which have been repeated in rapid 
succession ; occasionally it is caused by a single indulgence in some 
aliment difficult of digestion. Persons who have feeble or dyspeptic 
digestive organs, particularly if the bowels be constipated, are very 
liable to this affection if their habits be irregular. This is the form 
of fever that follows excessive indulgence, or a debauch of any kind. 
Rigor often ushers in the febrile symptoms ; the pulse is sometimes 
extremely rapid, the skin hot, the tongue is coated with a thick, white 
fur, and there are frequently nausea and an uneasy feeling in the ab- 
domen, which is more or less tumid. The bowels are always either 
constipated or there is diarrhoea, and when the latter symptom is 



INTERMITTENT FEVER. 75 

present, even when the stools are feculent, there is very generally 
reason to suspect, at least at the commencement of the disease, the 
existence of solid excrementitious matter in the cells of the colon. 
This affection is sometimes suddenly terminated by a copious per- 
spiration ; but, more generally, not until the bowels have been freely 
unloaded of their feculent contents ; and there are cases of obstinate 
constipation in which the febrile symptoms will not completely sub- 
side for six or eight days. 

In many cases this may be distinguished from typhus at the 
commencement by ascertaining the antecedent circumstances of the 
patient, and by the state of his bowels and abdomen. 

This is to be treated generally as ordinary simple fever. Trouble 
will result from the excessive irritability of the stomach, and the 
greatest difficulty will be found in the choice of some nutriment 
that will not be thrown up. Broth, made from hard clams of small 
size, taken without admixture, with nothing in it but salt, will al- 
ways remain, and will contribute greatly to the cure. 

INTERMITTENT FEVER. 

Intermittent fever, or fever and ague, is a disease consisting of 
paroxysms, or periods of fever, between each of which there is a 
distinct and perfect intermission from febrile symptoms. There are 
several kinds or species of ague ; but the quotidian, which returns 
every day ; the tertian, which returns every other day ; and the quar- 
tan, occurring on the first and fourth days, are the principal. There 
is another form of the disease in which there is a paroxysm every 
day, but at different hours. On one day the fit will come on in the 
forenoon, and the next day in the afternoon. This is not quotidian, 
but double tertian. The paroxysms that come in the morning of every 
other day are one tertian, and those that come in the afternoon of 
the alternate days are another. In quotidian, the paroxysm comes 
at the same hour every day. To this there is only the exception, 
good for all the forms, that the fit may come on an hour earlier or 
an hour later each successive day ; that which comes an hour earlier, 
or anticipates, indicates that the fever gains strength ; that which 
comes later, or postpones, indicates that the disease is losing its 
hold on the system, and will readily give way to treatment. In the 
same way, if quotidian agues lengthen their period, and change into 
tertian, it is a good sign ; but the mutation of a disease of a long 
interval into a shorter one denotes the increasing severity of the 
malady. Thus a quartan ague is not dangerous, but, if it be con- 
verted into a quotidian, it is then very dangerous. 



76 DISEASES OF THE GENERAL SYSTEM. 

Quartan agues, though less dangerous, are often very obstinate 
Debility predisposes to the disease, but the exciting cause is marsh 
miasma, or the effluvia from stagnant water, or marshy ground, im- 
pregnated with vegetable matter in a state of putrefactive decom- 
position. Dampness and the night air are particularly favorable to 
the full operation of marsh miasma. Ague does arise, however, 
from other causes than marsh effluvia ; and it may be produced by 
sympathy, or irritation in the stomach and intestines. Single par- 
oxysms of ague may indicate some disturbance of the urinary 
organs, as stone in the bladder. There is also what is called the 
brass-founder's ague, similar to intermittent in all essential points, 
which occurs among workmen exposed to the fumes of zinc liquefied 
by heat. 

Every fit of ague consists of three stages — a cold, a hot, and a 
sweating stage. In the cold stage, the face and limbs become pale, 
the features are shrunken, and sensibility is greatly impaired, the 
breathing short and anxious, and a sensation of a severe cold is felt 
over the whole body, succeeded by shivering and violent shaking. 
Afterward, the heat of the body returns, and soon becomes dry, 
burning, and much above the natural standard; the countenance is 
now flushed and tumid; there is often acute pain of the head, some- 
times slight delirium ; the pulse is strong, full, and frequent, and the 
thirst urgent. These symptoms are followed, first, by moisture of 
the skiu, and then by a universal and equable perspiration, which 
terminates the fit. 

In duration, the first stage varies from thirty minutes to three 
or four hours ; the second seldom lasts less than three or more 
than twelve hours, and the third may continue one or two hours. 
In the first, or cold stage, there are internal congestions, and this, 
in certain forms of the fever, is a period of great danger. Some- 
times, where the fever is very severe, this cold stage is fatal in 
the first paroxysm, destroying life by congestion of the brain or 
lungs. Reaction from this causes the peculiar phenomena of the hot 
stage, and the profuse sweat results from this great activity on the 
surface. 

In the intermission, the patient may enjoy ordinary health. 

Treatment. — Quinine is the great remedy. Give it in doses of 
one or two grains every second hour in the intermission, with a 
double or treble dose three hours before the time at which the ague 
should come on. Should the disease prove obstinate, the medicine 
may be given in larger doses. With the chill due at noon next day, 
in a very obstinate case give five grains over night, and the next 
morning at nine give 



INTERMITTENT FEVER. . 77 

Sulphate of quinine, 10 grains, 

Powder of capsicum, 5 grains, 

Opium, . 1 grain, 

and at noon a cup of strong coffee.. 

Quinine will act more efficiently if the stomach is first freely 
emptied by twenty or thirty grains of powder of ipecac. 

Generally, it is not necessary to give very large doses of quinine, 
and such doses are to be avoided when possible, for the disagreeable 
effects they have on many persons. If ordinary doses do not cure, 
they will be made effective by combination with other medicines, 
and effect is to be sought in this way rather than by larger doses. 
Should the pulse be hard and strong, and inflammatory symptoms 
be present, as pain in the side, etc., this state must be reduced by a 
low diet, and perhaps by taking away eight or ten ounces of blood 
from the arm. Otherwise the disease may yield readily when the 
quinine has been preceded by a light mercurial course. 

Commonly, when the disease resists quinine, it is because there 
is a complication of disease of the liver, and the treatment must be 
directed to this before remedies can be effective against the ague. 
Hence the benefit of combining with the quinine some hepatic stimu- 
lant, as taraxacum or blue mass, or the hydrargyrum cum creta. 
Sometimes, in protracted cases, where there is great debility, and 
where the patients are so feeble and so saturated with quinine that 
they can take it no longer, iron will cure the disease. Sulphate of 
iron may be combined with the sulphate of quinine, and will enable 
the system to tolerate the latter, or iron may be taken without qui- 
nine, and in combination with some other of the medicines having 
specific power over the fever, as arsenic. In districts where this 
fever is very prevalent, arsenic is much employed, and with great 
success ; but it is a remedy that ought never to be employed till 
other and less deleterious medicines have failed. Four drops of the 
liquor potassae arsenitis, gradually increased, if necessary, to six or 
eight drops, twice or thrice a day, will speedily cure the most obsti- 
nate agues. This is what is called the "tasteless ague-drop." 

Common black pepper will cure the fever alone, and, combined 
with quinine, both medicines will have greater activity. From two 
to twelve grains of an alcoholic extract of the pepper may be given. 

Those who wish to try a very cheap remedy should use the web 
of the black spider, which has a popular fame, and has been laudecl 
for its efficiency by scientific men. Ten grains taken two or three 
times, before the paroxysm is the stated dose. The following ac- 
count of its action is from a distinguished English practitioner : 

" The cobweb prevents the recurrence of febrile paroxysms more 



78 DISEASES OF THE GENERAL SYSTEM. 

abruptly, and more effectually than bark, or arsenic, or any other 
remedy employed for that purpose with which I am acquainted. The 
cobweb was rarely given before the subject was prepared by emetics 
or purgatives; and, given to a subject so prepared, it seldom failed 
to effect a cure comparatively permanent ; relapse or conversion into 
another form of disease being, upon the whole, a rare occurrence 
where the disease has been suspended by this remedy. If it was not 
given until the paroxysm was advanced in progress, the symptoms 
of irritation, viz., tremors, startings, spasms, and delirium, if such 
existed as forms of febrile action, were usually reduced in violence, 
sometimes entirely removed. In this case, sleep, calm and refresh- 
ing, usually followed the sudden and perfect removal of pain and ir- 
ritation. Vomiting, spasms, and twitchings in the bowels, were also 
usually allayed by it : there was no effect from it where the vomiting 
or pain was connected with real inflammation, or progress to dis- 
organization. In cases of febrile depression, deficient animation, and 
indifference to surrrounding objects, the exhibition of eight or ten 
grains of cobweb was often followed by exhilaration : the eye 
sparkled ; the countenance assumed a temporary animation ; and, 
though the course of the disease might not be changed, or the dan- 
gers averted, more respite was obtained from a pill of cobweb than 
what arises from, or belongs to, the action of wine, opium, or any 
thing else within my knowledge." 

From a remedy having such effects, it would be foolish to abstain 
for the fear of ridicule. It is known that strong impressions made 
on the mind will prevent a paroxysm of ague, and the secret of this 
cure may lie in the thought of the loathsomeness of the medicine ; 
but it is certainly not improbable that a product of the spider's body 
may have an energetic effect on the system, since some spiders 
secrete a very active poison. 

The swelling in the left side that this fever sometimes leaves, 
called ague-cake, is due to enlargement of the spleen. For the cure 
of this, depend upon continued use of quinine. 

It should be kept in mind that, where quinine fails to cure the 

fever, this failure is due to the fact that the patient's system is so 

saturated with malaria that the whole mass of blood is in a more or 

less depraved state. Quinine is not a specific for the cure of this 

poisoned blood, but iron is, and the blood must be brought to a 

better condition by iron before the quinine will have a satisfactory 

effect. 

REMITTENT FEVER. 

Remittent fever arises from malaria, as intermittent does, and is 
in some degree a modification of it ; but, because the poison is more 



INTERMITTENT FEVER. 79 

intense or more active, or the system in such a state as to make the 
poison more effective, through the condition of the stomach, liver, or 
intestinal canal, the febrile symptoms are without distinct interval. 
As an intermittent fever grows worse, it assumes the character of 
remittent — and it generally grows worse, not through increase of the 
peculiar poison, but through complication depending upon the dis- 
order of some organ. The influence of the state of the viscera in this 
disease is recognized in its common popular name, bilious fever. 

It begins as continued fever does, with chills, or a chilly sensa- 
tion, occasionally with an actual rigor ; with pain along the spine, 
and in the limbs, headache, depression of spirits, or even confusion 
of intellect. Febrile reaction follows ; there are heat, thirst, increased 
headache, dry, white, furred tongue, and a frequent, full, and some- 
times hard pulse. There is also at this stage an uneasiness at the 
pit of the stomach, a sense of weight, or pain, with nausea, and per- 
haps vomiting. The urine is scanty and high-colored, and the evacu- 
ations dark and offensive. 

This condition continues for from eight to fourteen hours, when 
the symptoms moderate or " remit," and there is more or less per- 
spiration. This relieves the patient, but he is never altogether free 
from his fever, and, after an uncertain interval, there is a recurrence 
of the febrile symptoms. There are different degrees of severity to 
this fever, as it varies all the way from intermittent to typhus. In 
some districts, and in certain seasons, its fatality is very great, but 
oftener it is without danger. 

The object of treatment is, to bring the fever as near as possible 
to the intermittent type, and then cure it with quinine. Where the 
remission is obscure, it will become more distinct by removal of the 
irritating cause in the intestine. Give five grains of hydrargyrum 
cum creta, and a few hours later a small dose of castor-oil, or ten 
grains of powdered rhubarb. Sponge the surface with tepid water, 
have the patient's room quiet, and with plenty of fresh air in it, and 
let no food be taken but gruel. If the pain at the pit of the stomach 
persist, and more especially if it go round below the ribs on the left 
side, apply, after the medicine has acted, from three to six leeches 
over the seat of the pain. If there be loss of sleep, give ten grains 
of compound powder of ipecacuanha at bedtime. Encourage per- 
spiration by giving the liquor of acetate of ammonia, a teaspoonful 
every two hours. Within two or three days this treatment will 
make the remission distinct, and then give quinine : 

Sulphate of quinine, 16 grains. 

Water, 2 ounces. 

Sulphuric acid enough to make the solution. 



80 DISEASES OF THE GENERAL SYSTEM. 

Give three to six teaspoonfuls of this a day. It will complete the 
cure. 

As there is no appetite, it would be hardly necessary to warn 
against imprudences in diet, if the over-anxiety of friends were not 
often a cause of trouble on this point. Let no solid food be taken 
till after the quinine has been in use two or three days, and then 
only of the lightest kind. 

YELLOW FEYEK. 

There are several degrees of severity in this disease ; the symp- 
toms in their general character being those of continued, or of ty- 
phoid fever ; the special character of yellow fever being given by an 
alteration in the constitution of the blood, more particularly mani- 
fested in disorders of the liver, stomach, and intestines. 

Commonly a severe shivering suddenly occurs, attended with 
headache, pains in the back and limbs, flushed face, bloodshot eyes, 
hot skin, tongue furred, with red tip and edges, nausea and vomiting, 
pain in the stomach, restlessness, drowsiness, bowels costive, urine 
scanty and high-colored. 

These symptoms may pass off on the second or third day, leav- 
ing only debility ; or the patient may be seized with sickness and 
vomiting of the contents of the stomach, and afterward of a dark- 
colored fluid, becoming darker until it resembles pitch. The occur- 
rence of black-vomit is generally, but not always, fatal. The coun- 
tenance becomes depressed ; the skin assumes a yellow tint, which 
spreads over the whole body. The vomiting continues, and occurs 
more frequently, attended with a peculiar hollow and loud noise. 
The patient retains his sensibility, is restless, desponding, and grad- 
ually sinks. 

In another form, the preceding symptoms appear with aggrava- 
tion. The black vomiting occurs earlier. Violent delirium early 
occurs. Bleeding takes place from the mouth, eyes, ears, and other 
outlets of the body. There is little urine passed. The tongue is 
moist and raw-looking. The yellowness of the skin speedily ap- 
pears. The attack is so rapid that the patient may be carried off on 
the second or third day. Perhaps there is no real difference in these 
forms ; only, in this second variety, the illness of the earlier days is 
less noticeable, and, as the patient keeps about, the characteristic 
features of the disease seem to be developed without warning. 

In another form the disease is equally severe and fatal, but is 
slower in its progress, each symptom enduring a longer time. The 
temperature of the surface of the body is less, and sooner falls below 



YELLOW FEVER. 81 

the natural standard. The pulse is more feeble, and sooner sinks. 
The disease has altogether, in this form, a typhoid character. 

In all these modifications, the great danger is from depression of 
the vital energies, change in the condition of the blood, and the ex- 
tent and frequency of black-vomit. A high degree of febrile or 
nervous excitement does not indicate so great danger as does this 
state of depression. In the majority of cases, distinct stages or pe- 
riods in the progress of the disease will be observable : first, lasting 
a few hours, the invasion characterized by shivering, headache, 
pains in the limbs, etc. ; second, lasting from two to three days, the 
stage of excitement in which all the febrile symptoms become aug- 
mented ; third, that of depression, or collapse, in which the worst 
symptoms appear, continuing from a few hours -to several days. 

The headache in this disease is peculiar, and is rather severe 
pain immediately above the eyes, the bones ache, and the immediate 
cause of restlessness is the pain in the joints. The vomit that comes in 
the first stage of the fever is not the black-vomit. When the early 
febrile symptoms pass away, the period that follows has been called 
the stage of calm. Dating from this period, there is positive change 
in the disease one way or the other ; those that are to recover begin 
to show it then, and those that are to die get worse. In this res- 
pite, the face clears up, the pain is no longer felt, and the coat peels 
from the tongue. This is followed in fatal cases by the collapse, in 
which the surface becomes cold, and the coffee-colored vomit occurs. 
This vomit is the result of haemorrhage in the stomach ; the same 
matter colors the stools. Hsemorrhages may occur in other organs, 
and there may be blood in the urine. 

Yellowness of the skin does not occur in all cases, and comes in 
any case only in the third stage. It must not be relied upon there- 
fore as a means of recognizing the disease, for, if the disease is only 
recognized when the yellowness appears, it will be too late for treat- 
ment to be of any avail. 

Xeither does the peculiar vomit occur in all the cases ; nor yet 
in all the fatal cases. 

It is a disease of warm climates and warm seasons only. In suffi- 
ciently high temperature it is epidemic, but is probably not conta- 
gious. 

TuEA-niENT. — Give at first one dose of calomel, ten grains, and 
keep the bowels free by rhubarb, oil^ or, better still, epsom salts, for 
two or three days of the first stage. This is only to be done if the 
patient is seen in the first stage. Some have in this stage applied a 
blister between the shoulders, and down the spine. It may moderate 
the symptoms. 



82 DISEASES OF THE GENERAL SYSTEM. 

In the second stage endeavor mainly to keep up free action tow- 
ard the skin. A foot-bath in the bed will accomplish this, and am- 
monia may be used with the same purpose. Give barley-water, toast- 
water, tea, and soda-water, made with carbonate of soda, or use this 
formula : 

Take of Carbonate of soda, 1 scruple. 

Common salt, 15 grains. 

Chlorate of potash, 7 grains. 

Mix, and give this in barley-water, every three or four hours. 

This is the best plan to prevent the third stage. 

Should, however, the third stage come on with its characteristic 
symptom of collapse, depend on stimulants. Use champagne and 
quinine. Give the champagne freely, and the quinine according to 
the appearance of nervous depression, and without any other limit. 
Give it in doses of five grains an hour ; but, if this does not mitigate 
the disease, give ten grains an hour, or twenty. 

INFLUENZA OR GRIP. 

This is an epidemic fever, with catarrh ; the poison seems espe- 
cially to affect the air-passages, and the person attacked has a cold. 

There are chilliness ; shivering ; headache ; sneezing ; hoarse- 
ness ; cough ; pains in the back and limbs ; general depression ; fe- 
verishness ; loss of appetite ; nausea ; furred tongue ; disordered bow- 
els ; dry skin ; quick and feeble pulse. Influenza thus presents all 
the features of a severe cold, but is, in addition, marked by prostra- 
tion of strength and distinct fever, and has much longer duration. 
It is generally epidemic over large districts, whereas cold or catarrh 
is more dependent on individual circumstances. 

Influenza is not unfrequently attended with severe inflammation 
of internal organs. 

It generally attacks the delicate ; and there is, also, a liability 
to the recurrence of the disease, which long remains in the consti- 
tution. 

Treatment. — Give aperients, as castor-oil, senna, a warm foot- 
bath, and sudorific drinks, barley-water, lemonade, or balm-tea. 
Treat, in fact, like a common cold, remembering only that the disease 
will not stand very energetic medicines, as it is one of debility. 

Food and regimen, calculated to restore the depressed vigor to 
the system, independent of medicine, are requisite ; and by, improv- 
ing the tone of the habit, we take the most effectual means of com- 
bating the liability to the recurrence of the disease, which is so 



SMALL-POX. 83 

peculiar to those who have once suffered it, and also shorten the pe- 
riod and lessen the severity of the convalescence. 

As in all diseases dependent upon atmospheric influence, quinine 
has peculiar power, and should always be given, in doses of three or 
four grains a day. 

SMALL-POX {Variola). 

Fully-formed small-pox is easily recognized. We suspect that a 
person taken with fever has the disease, if small-pox prevail, if the 
patient is "unprotected," and if he has been exposed to the 
disease within nine, ten, or fourteen days. Vomiting and pain of the 
back are common at the onset of small-pox, but not of continued 
fever. These, when violent, usually usher in a severe form of the 
disease. Heberden noticed that acute pain in the loins was almost 
always followed by a severe disorder ; that pain higher up, between 
the shoulders, was of better augury ; and that absence of pain was 
always reckoned a good sign. Early delirium, stupor, or convulsions, 
announce a severe case : this rule is less positive in regard to chil- 
dren. 

From the time when the disease is taken, until the fever comes on, 
there is a period of twelve days, and the eruption appears on the 
second day of the fever ; thus, from exposure to the eruption, there 
are fourteen days. There is a practical importance in keeping these 
numbers of days in view. If one fears, from exposure, that he has 
taken the disease, an immediate vaccination should be resorted to, 
as the vaccine disease runs its course in fewer days, and will modify, 
if it does not prevent, the other. 

Small-pox is divided into the discrete and confluent varieties. In 
the former, the pustules are distinct and of a regularly circum- 
scribed circular form ; in the latter, they coalesce, and their common 
outline becomes irregular. The former is scarcely ever dangerous ; 
the latter always is. 

In the discrete form the disorder runs its most natural course ; the 
eruption is at first pimply y the pimples begin on their third day to con- 
tain a little fluid on their summits. Then, for two days, they increase 
in breadth only, and in the centre of many there is a depression. On 
the eighth day of the disease, or the fifth of the eruption, the pustules 
are perfectly turgid and hemispheroidal. During the time they are 
thus filling up, the face swells often so much as to close the eyelids 
and change the features. The skin between the pustules on the face 
assumes a damask-red color. About the eighth day of the eruption, a 
dark spot appears on the top of each turgid pustule, and at that 
spot the cuticle breaks, a portion of the matter oozes out, and the 



84 DISEASES OF THE GENERAL SYSTEM. 

pustule scabs. At length this crust falls off, leaving either a charac 
teristic purplish-red stain, which very slowly fades, or an indelible 
depressed scar ; the patient is pitted or pock-marked. The swelling 
of the face begins gradually to diminish after the eruption has be- 
come thoroughly pustular. This is the course of the eruption on 
the face, where it is usually thickest in both forms of the disease. 
The same course is pursued, only two or three days later, on the ex- 
tremities where it begins later. Some of the pustules, especially on 
the extremities, never burst, but shrivel up. In this form, the fever 
generally ceases entirely upon the coming out of the eruption ; the 
headache, the pain of the back, the vomiting, the restlessness, abate 
and disappear ; the pulse and skin become natural. About the seventh 
or eighth day of the eruption, there is commonly, for a day or two, 
a recurrence of the fever. Pustules, confluent over the whole 
body, are less regular in their progress than the discrete. The 
eruptive fever is usually more violent and tumultuous ; the dis- 
turbance of the sensorial functions is more common and more de- 
cided, the sickness more distressing, the pain in the back and loins 
more severe. The eruption comes out earlier and more confusedly, 
the pimples being at first very minute and crowded into patches, 
and often accompanied by a rash like that of scarlet fever or erysipe- 
las, thus rendering the diagnosis, so far as it depends on the appear- 
ance of the skin, for a while uncertain. It -is sometimes like that of 
measles ; but the appearance soon of fluid, on the summits of the 
pimples, dispels the uncertainty. The pimples do not, as they ad- 
vance into pustules, fill up so completely as in the discrete form ; 
they are flatter, more irregularly depressed, and even of a different 
color, being first whitish, then brownish, and seldom of the yellow 
purulent hue of the discrete form. Sometimes they are even bluish, 
or purple. There is commonly some abatement of the febrile distress 
on the coming out of the eruption, but it is much less marked than 
in the discrete. 

There is danger from the eighth day until the fourteenth. From 
the fourteenth day, cases begin to get well. 

Tkeatmeistt. — If the case is a mild one, it needs only proper nurs- 
ing. Give cooling drinks, and apply cooling lotions to the surface, but 
not to such an extent as to interfere with the development of the pus- 
tules. Use a mask of cotton covered with oil, to prevent pustules on 
the face. Carefully protect patients from the influence of cold, but do 
not go to the other extreme, and keep the room over-warm. Keep- 
ing the patient in a high temperature, and giving warm stimulant 
drinks, have been proposed as a regular method of treatment, and 
tired, with disastrous results. It increases greatly the develop- 



SMALL-POX. 85 

ment of the pustules ; and, as the pustules in many ordinary cases 
excite a secondary fever, but few systems can endure the increased 
excitement that results from excessive eruption. Keep the bowels 
open, by mild laxatives. Great harm will be done by giving medicine 
actively, at the onset of the disease. It wastes the strength that 
will be wanted by-and-by. Commonly all the febrile symptoms 
are easier immediately after the eruption, and this has led to the er- 
ror of hastening and stimulating this crisis, the danger of which we 
have referred to. This popular delusion has its hecatomb of victims 
every year. Nausea, in the early period of the disease, may be a 
consequence of the severe headache ; but, if there is a foul tongue 
and a bad taste in the mouth with it, it is probably due to a dis- 
ordered stomach, and will be relieved by twenty grains. of ipecac. 

Severer cases indicate a more deeply-poisoned state of the blood. 
In these, the secondary fever, that comes on in consequence of the ex- 
tensive irritation of the skin by the pustules, is, in fact, the worst form 
of typhus fever, and must be treated as such, except that it will not 
do to use medicines tending so much to increase the action of the 
skin. Give moderately-cooling drinks, move the bowels by injec- 
tions, rather than by purges, and prevent exhaustive wakefulness by 
the use .of opium, giving a grain at bedtime. Tonics may be neces- 
sary in the course of this fever, and the best for the purpose is the 
tincture of cinchona, in drachm-doses, given twice a day. 

Guard particularly the eyes. Pustules, remember, are likely 
to occur anywhere. They may come in the throat, and make neces- 
sary the use of a very active gargle, as strong alum-water, or they 
may come in the trachea, and start a suffocative, troublesome cough, 
for which opiates will be the only remedy. They will come also on 
the globe of the eye, and destroy sight. Guard against this by 
keeping the eye cool with cloths dipped in cold water. 

Barley-water, rice-water, whey, and gruels, are the proper food. 
There will be but little desire for food, and the danger of oppressing 
the system by stuffing can only arise through the apprehension of 
friends. Never permit two or three children ill with the disease to lie 
in the same bed, or the feeblest one will surely die, while, in a room or 
bed by itself, it would have an equal chance with the others. Keep 
the person as clean as the circumstances will permit, by proper change 
of linen. 

The use of sulphite of soda has been proposed in this and 
some other diseases of the same nature, on the theory that it acts in 
the blood as an antidote to the poison. It certainly seems to have 
some effect in moderating the violence of the disease. 

Give ten to twenty grains, in water, every fourth hour. 



86 



DISEASES OF THE GENERAL SYSTEM. 



VACCINATION. 



Every unvaccinated person is liable to small-pox, and may, there- 
fore, also become the source of infection to others. At the same 
time, he has only two chances to one of escaping with his life ; and, 
even if he be so fortunate, his countenance is disfigured, and his 
health probably impaired for life. 

The only safe and certain preventive of this fatal and loathsome 
disease is vaccination. This is proved — 1. By the fact that, in 
proportion as vaccination is properly and efficiently performed, so 
the mortality of small-pox is reduced; 2. By the freedom from 
infection enjoyed by well-vaccinated persons in contact with small- 
pox patients. 

The first point is further illustrated by statistics, which show the 
mortality of small-pox to have been 96 per 1,000 in the fifty years 
preceding the introduction of vaccination, and 35 per 1,000 in the 
fifty years subsequently. This reduction of mortality has gone on 
progressively in those countries where the performance of vaccina- 
tion has been rigidly enforced by the governments. Thus the mor- 
tality of small-pox before and after vaccination was — 





Before Vaccination 
was introduced. 


After introduction 
of Vaccination. 


Lower Austria, 
Upper Austria, . 

Trieste, 

Prussia (Eastern), 
Prussia (Western), . 
Saxony, . . . . 
Sweden, . . ... 


Per 1,000. 

67 

46 
142 
111 

75 
27 
71 


Per 1,000. 

7 

6 

6 
12 
10 

8 

2 



In Sweden the laws regarding vaccination are most stringently 
carried out, and in that country the mortality from small-pox is 
lowest. 

Make the punctures for vaccination quite superficially. Be 
sure that the matter comes from a good source ; and, if taken from 
a pustule by the operator, that it was taken between the fifth and 
ninth days, and was perfectly transparent. The natural and proper 
progress is as follows : The puncture disappears soon after the in- 
sertion of the lancet ; but, on the third day, a minute inflamed spot 
becomes visible. This gradually increases in size, hardens, and pro-- 
duces a small circular tumor, slightly elevated above the level of the 
skin. About the sixth day, the centre of the tumor shows a discol- 



SCARLET FEVER. 87 

ored point, formed by the secretion of a minute quantity of fluid ; 
the point augments in size, and becomes a manifest vesicle, which 
continues to fill and to be distended till the tenth day ; at which 
time it displays in perfection its peculiar features. Its shape is cir- 
cular, sometimes a little oval ; but the margin is always well turned, 
and never rough or jagged ; the centre dips instead of pointing, and 
is less elevated than the circumference. A beautiful circular and 
circumscribed areola almost always surrounds the pustule ; and this 
areolar efflorescence is usually in its perfect state about the seventh 
or eighth day. In spurious affections of this kind, an irregular 
superficial inflammation occurs on the first or second day after the 
appearance of the pustule ; and the pustule itself appears more like 
a common festering sore produced by a thorn, than a pustule excited 
by the vaccine virus. 

Ideas of beauty are comparative. To Jenner's eyes the vaccine 
eruption altogether resembled " a split pearl laid on a rose-leaf." 

According to Dr. Willan, the vaccine vesicle is to be regarded 
as imperfect when — 1. Though perfect in its form and appearances, 
it is without an areola on the ninth or tenth day ; 2. When the 
vesicle is very small, pearl-colored, flattened, with a hard, inflamed, 
and slightly-elevated base, a dark-red areola, and without a rounded 
or prominent margin ; 3. When the vesicle is small, pointed, with a 
very extensive pale-red areola. The spurious disease may be pro- 
duced — 1. By the genuine vaccine virus acting on a system affected 
with some cutaneous disease ; 2. By vaccinating with matter which 
has undergone more or less decomposition by long keeping ; 3. By 
vaccinating with matter taken from a spurious pustule ; and 4. By 
the genuine vaccine matter being controlled, or in some way diverted 
from its regular operation by idiosyncrasy, or a depraved condition 
of the system. 

It is rare that any medical treatment is necessary. Any excess 
of inflammation should be repressed by the application of cloths 
dipped in cold water, or in the following lotion : 

Liquor ammonia, 2 drachms. 

Alcohol, . . . .1 ounce. 

Water, .......... 5 ounces. 

If there should be severe constitutional disturbance, give an 
aperient, magnesia and rhubarb, and small doses of diaphoretic, ten 
or twenty drops an hour, of the liquor of acetate of ammonia. 

SCARLET FEVER. 

After the existence of febrile symptoms and general indisposition, 
with more or less sore throat for a period varying from one or two 

7 



88 DISEASES OF THE GENERAL SYSTEM. 

to four days, the skin becomes hot, and an eruption appears, con- 
sisting of minute scarlet points collected in patches, or forming a 
diffused color, like that of a boiled lobster, over the greater part of 
the body. This rash lasts about five to seven days, and then dis- 
appears, leaving the skin harsh and dry, or scurfy, or peeling off in 
thin scales. The peeling of the skin is sometimes deferred for sev- 
eral days after the disappearance of rash and fever. "While the rash 
is out, it causes itching or tingling of the skin. The tongue presents 
a characteristic appearance : it is white or furred, but with this are 
seen the minute papillae of the surface prominent, and of a scarlet 
color, giving the likeness of a raspberry. Or the fur may be want- 
ing, and the tongue be entirely scarlet, but presenting the same 
enlarged papillae. The throat likewise is reddened, the tonsils en- 
larged, scarlet, and ulcerated ; swallowing is painful. 

While the eruption is out, if the disease be of an active or severe 
character, the countenance is expressive of anxiety; the eyes are 
brilliant; there may be delirium: the patient is restless and sleep- 
less ; there is great thirst ; nausea or vomiting ; rapid pulse ; quick- 
ened breathing ; costive bowels ; scanty, high-colored urine. 

The rash appears first on the face, then spreads to the neck, chest, 
and trunk, and passes off by the extremities. When the throat is 
much affected, and the disease is severe, there is often some delirium, 
and the strength fails. This is especially the case when the fever is 
of a low or typhoid kind ; when the throat is much swollen or ul- 
cerated and the eruption appears in irregular blotches, or becomes 
livid ; when the tongue is dry, brown or black, or smooth and 
glossy ; the nostrils discharging an acrid matter which excoriates 
the upper lip, and bleedings taking place from the mouth, lungs, and 
bowels. 

In many cases, the sore throat, by the putrid and malignant char- 
acter it assumes, becomes the principal disease. Cases occur in 
which the characteristic rash is absent, when congestion of the brain 
will probably divert attention from the other features of the disease. 

Teeatment. — The practical point is to endeavor to assist the 
constitution in throwing off the poison which gives rise to the dis- 
ease, or to support the system while that is effected. This may be 
done, in the milder cases, by doses of carbonate of ammonia every 
four hours, and by frequently sponging the surface of the body with 
tepid vinegar-and- water ; at the same time an aperient should be 
given if the bowels be costive. The room should be freely ven- 
tilated, taking precaution that the temperature of the surface of the 
patient's body be not suddenly lowered, as the eruption would thereby 
be checked. The thermometer should stand at about sixty degrees 



SCARLET FEVER. 89 

in the chamber. The diet should be light. Acidulated beverages 
and simple fluids may be freely allowed. As the fever declines, mild 
tonics, as citrate of iron, or quinine, may be given. Beef-tea, wine, 
etc., carefully allowed. A gargle will relieve the sore throat, or it 
may have a solution of nitrate of silver (15 grs. to the oz. of water) 
applied to it with a sponge tied to a slip of whalebone. 

In the more severe and active inflammatory form, in which the 
throat is ulcerated, it may be touched with a stronger solution 
of nitrate of silver (1 drachm to the ounce of water) two or three 
times a day. A poultice of bran or bread-crumb should be applied. 
Tincture of iodine may afterward be freely painted on the outside 
of the throat two or three times a day. When the throat sloughs 
and the febrile symptoms are less active, or have declined, a more 
liberal diet should be allowed. Strong beef-tea, etc., and wine, 
and tonics, such as mineral acids, should be given. 

In the malignant or worse forms, bark and ammonia with wine 
or brandy every two, three, or four hours, according to the degree 
of depression or debility, must be given at the commencement. The 
skin should be sponged with warm vinegar. If the eruption do not 
appear freely, or be of a dark or dull color, the patient should be 
placed in a hot bath in which mustard has been diffused. The prin- 
ciple to be borne in mind in such severe cases is, to support the con- 
stitutional powers, and thereby enable the system to throw off the 
poison by the skin, kidneys, etc. 

The bowels should be kept open with small doses of castor-oil ; 
indeed, this attention to the bowels, and small doses of acetic acid, 
constitute the best treatment for ordinary cases. 

Acetic acid, ■. . . 1 ounce. 

Water, 3 ounces. 

Syrup, ^ ounce. 

Mix, and give a tablespoonful, once in three hours, to a child six years old. 

When the disease is mild, little more is required than to remem- 
ber that it has a definite limit, and watch the periods of the disease, 
keeping the patient in bed, on a spare, fluid diet. 

In convalescence from scarlet fever, take the utmost care to pre- 
vent a too early exposure to cold, as it will produce Bright' s disease 
of the kidney. Children that have gone safely through the disease 
proper are often victims to want of care in this respect. In the dis- 
ease itself there is a natural tendency to the affection of the kidney, 
which imprudent exposure increases. The kidney affection is more 
likely to occur where the eruption has not come out freely. 



90 DISEASES OF THE GENERAL SYSTEM. 



MEASLES. 

As in the other eruptive fevers, the days that immediately suc- 
ceed exposure to the disease are without any indication that it has 
been taken. The first sign of the invasion of the disease is a chill. 
Sometimes there is one distinct chill, oftener there are several 
slighter ones. Then come all the symptoms of an intense catarrh 
with active fever. There are a rapid pulse, general uneasiness, head- 
ache, pain in the limbs, nausea, vomiting, agitated sleep. The only 
early peculiarity is the intensity of the catarrhal symptoms. The 
eyes are brilliant or suffused, and constantly bathed in tears, and 
the nose is, as the phrase goes, " stopped up," but discharges freely 
an acrid, thin mucus. There are paroxysms of sneezing, which are 
sometimes very violent, and there is a fatiguing cough, and occa- 
sionally symptoms closely resembling spasmodic croup. These 
symptoms generally continue three days, but may continue 
longer, and the case may through this whole period be mis- 
taken for a severe cold, if there is not at the time an epidemic of 
measles. 

Sometimes there is diarrhoea, and often vomiting, which ceases 
when the eruption comes out. The eruption appears, as a rule, on 
the fourth day ; seldom earlier, often later ; sometimes as late as 
the eighth or tenth day from the beginning of the catarrh. It 
is a rash of, at first, very small pimples, which, as they increase, 
run together into blotches of a shape somewhat like a horseshoe, 
with skin of natural color between these blotches. It is two or 
three days in coming out, beginning on the face, neck, and arms, 
then reaching the body, and then the lower extremities; in this 
course it resembles small-pox. It fades, becoming browner, in the 
same order, having stood out three days at least on the face ; so its 
whole duration is six or seven days. It is slightly elevated, espe- 
cially on the face, which is somewhat bloated and swollen. The 
cuticle does not peel off in large flakes, as it often does in scarlet 
fever, but a great part crumbles away. Occasionally, a few small, 
short-lived vesicles intermix with the rash. The fever of measles, 
unlike that of small-pox, does not cease, nor abate, upon the emer- 
gence of the eruption, but sometimes becomes worse, and there may 
be convulsions. Measles, unlike small-pox, are not more severe, nor 
more dangerous, because the eruption is plentiful or early ; indeed, 
the contrary is sometimes the case. 

Sometimes the measly rash may occur without the characteristic 
symptoms of fever and cold, when it is called measles without 
catarrh. This form of disease affords no protection to the system 



CHICKEN-POX. 91 

against the regular measles. Another form is occasionally seen, 
called putrid measles. 

The eruption appears unusually early, so early as the second 
day ; besides cough and dyspnoea, there will be extreme debility and 
painful diarrhoea ; gangrene often occurs both internally and exter- 
nally. In this form, the rash is often irregularly and imperfectly 
developed and livid, and the sufferers seem to die of the intestinal 
disease that causes the diarrhoea. 

In ordinary measles, where it is fatal, death is commonly caused 
by inflammation in the chest, bronchitis, or pneumonia. In children 
predisposed to consumption, measles may light up that disease. 

Treatment. — Slight cases require little more than judicious do- 
mestic attention. Cold air to the surface must be especially 
guarded against, on account of the chest-symptoms. Therefore, 
keep the patient in bed, with the clothes and warmth of the apart- 
ment to which he is used in health ; feed him on gruel. If the bow- 
els are not open, give gentle laxatives, as rhubarb or seidlitz pow- 
ders. Some diaphoretic may be ordered : 

Camphor julep, • . 1 ounce. 

Liquor of acetate of ammonia, 3 drachms. 

Sweet spirits of nitre, . % drachm. 

Half of this mixture is a dose, and have the mixture made twice in the day. 

Watch very closely the pulmonary symptoms. These at first al- 
most always depend on bronchitis, which is apt to run into pneumo- 
nia. Extensive bronchitis is what we have for the most part to 
dread. Treat as in bronchitis and pneumonia. Give tartar-emetic. 
When the rash is about to decline, a spontaneous diarrhoea often sets 
in, and appears to abate the febrile symptoms. If it fail to occur, 
give gentle aperients. If the eruption disappear prematurely (a 
bad sign), it may sometimes be restored by a warm bath. Counter- 
act any low state of the patient, especially putrid symptoms, by 
wine and animal broths — cautiously watch their effects. After 
recovery, the patient should wear warm clothing, should not go out 
too early, or expose himself to cold ; otherwise inflammation of the 
lungs, and dysenteric purging, will often result. 

CHICKEN-POX ( Varicella). 

There is an eruption of small pimples on the back, chest, shoul- 
ders, neck, and face. These pimples on the second day become vesi- 
cles, L e., each consists of a minute bladder, containing a faintly- 
yellowish, clear fluid. On the third day, or it may be the fourth, 
the fluid has become opaque, and the vesicles are then considered 



92 DISEASES OF THE GENERAL SYSTEM. 

mature or at their height. After this a thin crust or scab forms, 
and falls off by the fifth or sixth day, without leaving any mark. 
There is no fever in the greater number of cases. Sometimes the 
pimples are very numerous, longer in their course, attended with 
some feverishness ; and, when they have died away, leave a few 
scars behind. 

Distinguished from small-pox by the rapidity of its course, the 
vesicles drying in three or four days, the globular form of its vesi- 
cles, and the absence of fever. .The vesicles of small-pox have a de- 
pression on the middle of their surface, and they take eight days to 
reach their height and several days more before they dry into scabs. 
It is difficult, however, in some cases to distinguish between 
severe chicken-pox and mild small-pox as modified by vaccination. 
But note in the present disease the absence of a firm base to the 
vesicles. The vesicles of small-pox, whether modified by vaccina- 
tion or not, have generally a ring of inflammatory redness around 
their base ; this is absent from the vesicles of chicken-pox, which 
have some resemblance to a globule of water dropped on the surface. 
Small-pox appears more thickly on the face than chicken-pox does. 

Treatment. — This disease is entirely free from danger. It re- 
quires no further treatment than a light diet, and sometimes a mild 
aperient. 

ERYSIPELAS. 

Symptoms. — Redness, heat, and swelling of the skin of any part 
of the body, spreading superficially, attended with feverish constitu- 
tional disturbance, thirst, loss of appetite, rapid and feeble pulse. The 
swelling is slight, the color shining red,disappearing on slight press- 
ure, leaving for a few seconds a white spot or impression of the fin- 
ger. This inflammation of the skin is attended with heat, pricking, 
or burning, and a sense of weight and tension, and has a distinct 
sharp outline, the redness at the edge being as decided as that in 
the middle. It does not shade away ; this will enable any one to 
distinguish between erysipelas and other diseases of the skin bearing 
some resemblance to it. 

After an uncertain time blisters frequently form, containing a 
clear yellow fluid. The inflammation is prone to spread to adjoin- 
ing parts as it declines in its preceding seat. "When it is situated 
on the head and face it is attended with danger, as it is then apt to 
give rise to inflammatory disorder of the brain. 

It is a disease of debility. Certain conditions of the atmosphere, 
and the impure air of crowded hospitals, strongly predispose to it, as 
do also habits of intemperance, or any other causes that depress the 



ERYSIPELAS. 93 

vital energies, under which circumstances the slightest wound or 
scratch will occasion the recurrence of the disease. Exposure to 
cold will excite it, without the aid of any wound or external injury. 
Indiscretion in diet, or partaking of unwholesome food, will excite it, 
where the predisposition is strong. 

Erysipelas may become an infectious disease in places where 
pure air, ventilation, and cleanliness, are not strictly observed. It 
also occasionally prevails in an epidemic form. 

There are two extremes to this disease, tending toward one or 
the other of which, it requires a different treatment. In one case, it 
is all fever, and the erysipelatous state of skin bears the same rela- 
tion to the fever that sore throat may in scarlatina, or the abdominal 
disturbance in typhoid ; in this case, treat it as fever, dusting flour 
only on the eruption. In the other case, it is an inflammation of the 
skin, dependent upon debility ; and here, therefore, it must still be 
treated as a disease likely at any moment to run into fever. Graves 
treated the disease successfully with tonics, stimulants, and narcotics. 
Trousseau regards the muriated tincture of iron, in doses of fifteen 
or twenty drops, seven times a day, as nearly specific ; and Yelpeau 
applied to the surface a lotion made as follows : 

Sulphate of iron, 1 ounce. 

Water, 1 pint. 

Apply compresses, soaked in this, on the seat of the disease. It 
is exceedingly effective ; under its use, the swelling decreases, and 
the pain and heat disappear. 

The bowels and liver are always in a very bad state, and no 
amendment can be counted upon till these are put right. Five 
grains of hydrargyrum cum creta should be given for two or three 
successive days, and the bowels kept clear by saline aperients, as 
the citrate of magnesia, or Congress-water. 

In cases in which there are irritability and restlesssness, use the 
sulphate of morphine, to soothe during the day, and get sleep at 
night. Give, at night, half an ounce of the solution, that contains 
one grain to the ounce, and during the day give from thirty to sixty 
drops of the same, once in two or three hours. 

Attempts have been made, with some success, to control this dis- 
ease by applications that exclude the air. The simplest of these is 
common white paint. Paint the whole inflamed surface, and let the 
pigment extend a little beyond the line of redness. Collodion may 
be applied in the same way, or the following mixture : 

Collodion, . . . . , , . . . 4 ounces. 
Castor-oil, -Jounce. 



94 DISEASES OF THE GENERAL SYSTEM. 

Or collodion may be mixed in equal parts with the ethereal tincture 
of chloride of iron. 

There may be many subcutaneous abscesses, after erysipelas, 
and also abscesses in internal organs. Subcutaneous abscesses 
should be opened as soon as discovered, and during the time they 
are discharging the patient -will need to be well supported with iron, 
sulphate of quinine, beef-tea, and probably wine. 

HECTIC FEVER. 

Symptoms. — Emaciation ; increased frequency of the pulse ; quick- 
ness of breathing ; heat of skin ; thirst ; occasional flush on the 
cheek ; slight shiverings, followed by profuse perspiration ; bowels 
irregular; urine high-colored, and depositing a brickdust-looking 
sediment. The symptoms are aggravated toward evening. The flush 
on the cheek becomes more constant as the disease advances ; the 
tongue becomes dry and red, and thrush appears upon its surface ; 
the bowels become relaxed ; wasting sweats take place at night, or 
on falling asleep during the daytime ; the ankles and feet swell ; 
and, if the progress of the disease be not checked, the patient sinks 
from sheer debility. 

Generally, this is secondary to some evident or concealed chronic 
disease — such as slow inflammation, ulceration, abscess, etc., of inter- 
nal organs, involving perhaps the contamination of the blood by ab- 
sorption from the diseased organs ; disease of bones ; extensive or 
frequent loss of blood ; mental impressions ; disappointed affection ; 
harass and over-fatigue of body or mind. 

Treatment. — Our means must be directed to the removal of any 
evident cause. If, however, the cause be some obscure or concealed 
malady, we should follow the principle of supporting the powers of 
the system by tonic medicines and a nutritious diet, with exercise in 
the fresh air, bathing, etc. Profuse perspiration may be checked 
by any of the following preparations : 

Sulphate of zinc, 3 grabs. 

Diluted sulphuric acid, . . -£■ drachm. 

Syrup of lemon, i ounce. 

Water, 2£ ounces. 

Take a tablespoonful twice a day. 

Muriated tincture of iron, 1 drachm. 

Water, H ounces. 

Take a tablespoonful two or three times a day. 

Strong decoctions of sage-leaves (sage-tea) will often check this 
discharge effectively. 



scurvy. 95 



SCUKVY (Scorbutus). 

Symptoms. — These are general debility, lassitude, lowness of 
spirits ; the gums become swollen, spongy, or purple, and bleed on 
slight friction. The odor of the breath is offensive. The patient suffers 
from pains in the limbs, stiffness of the joints, and is averse to any 
exertion. The skin is dry and harsh, shining, and discolored with 
streaks of blue, greenish-black, or livid hues, resembling those of 
bruises. These patches are first observed, and are most numerous, on 
the thighs and legs ; they soon appear on the arms, body, and scalp 
but rarely on the face, which assumes a dingy, bloated hue. The 
ankles and legs swell. The disease persisting, all these symptoms 
become more distinct and severe ; haemorrhage from the nostrils, 
mouth, bowels, etc., is added ; swellings occur in different parts, and 
ulcers form on the legs, discharging a thin, fetid fluid. The bowels 
are generally more or less disordered from the beginning, and after a 
while become affected with the disorder known as " scorbutic dysen- 
tery." The pulse is feeble, often rapid. The tongue is flabby, and 
marked with furrows by the teeth. The appetite is not impaired 
until the latter stages of the disease. 

This disease is caused by deficiency of succulent vegetables and 
fruits ; the use of unwholesome provisions and water ; exposure to 
cold and moisture ; previous diseases, e. g., fevers. 

Treatment. — 1. Preventive. — Supply fresh acidulated fruits, as 
limes, lemons, shaddocks, oranges, pomegranates, tamarinds, etc., 
fresh vegetables, fresh meat. Among antiscorbutics are also the 
following: tops of firs and mountain-pines; tar-water; molasses; 
wort, or infusion of malt ; various fermented liquors and wines ; 
vinegar ; mineral acids ; cocoa, tea, etc. 

2. Curative. — When the disease has appeared, the free use of the 
above-named articles may be regarded in the light of medicines, at 
the same time that tonics are taken ; mild aperients if the bowels be 
costive. Diarrhoea may be checked by chalk-mixture or creasote, 
and dysentery by Dover's powder. Lemon-juice alone will cure the 
disease. Give it freely ; give also the chlorate or tartrate of potassa, 
ten or fifteen grains, three times a day. 

Purpura is another form of this disease, and yields to the same 
treatment. 

CHOLERA. 

There is a poisonous substance of unknown origin circulating in 
the blood, and this produces all the phenomena of the disease, by 



96 DISEASES OF THE GENERAL SYSTEM. 

its effect on the sympathetic system of nerves. It first simply irri- 
tates, and thus induces the premonitory uneasiness that usually 
occurs. The irritation, increasing in severity, next brings on the 
spasmodic contractions of muscles that make the excessively pain- 
ful cramps. This spasmodic action affecting the muscles in the 
walls of the small arteries, the arteries themselves are contracted, 
and the circulation ceases. The interruption of the circulation has 
this particular result in the lungs : it entirely prevents those changes 
of the blood that respiration should effect (see account of Circulation 
in chapter on Physiology). The current of blood through the lungs, 
by which the venous blood that goes from the right side of the heart 
should be returned as arterial blood to the left side of the heart, is 
stopped entirely ; and thus the whole mass of the blood becomes 
jammed in the large veins that lead to the right side of the heart, 
and there is no longer in the body any of the red blood that sustains 
life. Consequently there is loss of animal heat, loss of natural color, 
loss of the function of all organs ; the body is cold, blue, in a death- 
like state, and the vessels of the intestines, loaded with this blue 
blood, are relieved from the pressure by the escape, through the 
walls, of the fluid part of the blood which is poured from the bowels 
in copious watery evacuations. 

The symptoms of cholera are consonant with this history. There is 
first a premonitory looseness of the bowels, lasting for several days, 
or only for a few hours, generally with little or no pain. Following 
this, is the spasmodic action that closes the small arteries, and 
arrests the circulation — but this may as a spasm escape observation 
— it will however, be immediately seen in its effects. The sufferer 
suddenly has a sinking feeling, or faintness, sickness, and a profuse 
watery purge. This is rapidly followed by vomiting, and purging 
of thin motions resembling rice-water, or thin gruel, often with a 
peculiarly offensive odor. Severe cramps soon appear in the mus- 
cles of the abdomen, thighs, legs, hands, and arms. The tongue is 
cold ; there is great thirst. The urine is suppressed. The surface 
of the body is cold, and bathed in clammy sweat, and looks blue. 
The pulse is small, rapid, and soon imperceptible. The voice has a 
peculiar whispering character. In this state the patient dies, if the 
spasm that closes the arteries is not relaxed, and the blood again 
started on its course through the system. 

Treatment. — The first object is to relax the spasm. Use the 
following mixture : 

Chloroform, 1 drachm. 

Oil of turpentine, 1 ounce. 

Water, . . . 3 drachms. 



CANCER. 97 

Give a teaspoonful of this, and apply mustard-plasters over the 
whole abdomen, keeping the patient quiet in a warm bed. Relieve 
thirst by giving as much cold water as can be taken. Should the 
symptoms not subside, repeat the dose in half an hour ; but, should 
they subside for a time and come on again, repeat the dose then. 
If the vomiting should be so urgent a symptom that the medi- 
cine cannot be kept on the stomach, remember that the vomiting 
itself tends in the direction the treatment should take. Encourage 
the vomiting, therefore, by giving plenty of water, or even mustard 
and water ; and at the same time administer chloroform by inhala- 
tion. Give it carefully, and not so as to put the patient profoundly 
under its influence. Where this treatment fails, all treatment would 
be useless, from the greater susceptibility of the system to the in- 
fluence of the poison. 

Much success has attended the use of camphor dissolved in chloric 
ether, which also is a treatment aimed to relax the spasm ; and 
probably more was due to the ether than to the camphor. It is best 
to adhere to the one most efficient agent, for it is a disease that af- 
fords no time for the trial of different remedies. 

In the successful cases the patients become warm, and perspire 
freely when fully under the treatment, and are perhaps prostrate. 
It will be necessary then to stimulate gently with brandy and water, 
but in this always suppose that you may again excite the diseased 
action, and proceed with corresponding care. 

Treat as fever the state in which the patient is left when the 
active disease is subdued. 

In this account of treatment it is supposed that the patient will 
be in the dangerous stage before the recognition of the disease. 
Should the prevalence of cholera lead to the supposition that a 
diarrhoea coming on without known cause was but the commence- 
ment of this malady, treat that diarrhoea with castor-oil. The notion 
that a choleraic diarrhoea should be immediately checked was an 
error of the past. 

Some success has attended the use of a solution of morphine, 
given by the hypodermic method, that is, injected under the skin. 
In this way, the system may be brought under the influence of a 
medicine that seems to fail in these cases when given by the stom- 
ach. Give an eighth of a grain in solution. 



CANCER. 

In the first stage there is a hard tumor attended with little or 
no pain ; insensible to the touch ; unequal or irregular on its sur- 



98 DISEASES OF THE GENERAL SYSTEM. 

face. In its second stage it ulcerates and becomes the open, cancer- 
ous sore, discharging a thin, acrid fluid, and attended from the first 
with severe pain, of an acute, cutting, or stabbing character. The 
ulceration spreads to the surrounding skin, and the adjoining 
glands are irritated ; lastly, the blood becomes vitiated ; the powers 
of life fail. 

The most frequent external seat of cancer is the breast of fe- 
males ; internally, the womb or the stomach. Other parts of the 
body or of the skin may be its seat. It is likely to occur in the 
rectum, liver, bones, skin, brain, eye, lymph glands, testicle, ovary, 
tongue, and oesophagus. Cancer seldom occurs under thirty years 
of age. 

Other tumors, not of a malignant or fatal kind, may be mistaken 
for cancer. Thus it very often occurs that a portion of the female 
breast becomes hardened after nursing, or in young girls. This 
tumor is not so hard or insensible to the touch as cancer in its first 
stage. It will remain in its form of tumor many months, but never 
proceeds to ulceration, and generally disappears if pregnancy occur. 
Simple hardening of any part or organ is usually preceded by in- 
flammation, and disappears on amendment of the general health. 

Causes. — Hereditary tendency ; anxiety and distress of mind ; 
depressing passions ; bad and insufficient food ; external injury, as 
blows, etc. 

Treatment. — In its earlier stages much good may be done by 
medicines selected for the debilitated state of health. All means of 
cheering the spirits, external application of opiates, and other sed- 
atives, will be serviceable. Avoid every thing that may irritate or 
accelerate ulceration. Narcotics and sedatives to be taken also, to 
relieve pain. 

In the later stages, when the disease assumes the character of a 
malignant ulcer, treatment is mainly directed to moderate the disa- 
greeable character of the discharge, and to soothe pain. Extract of 
conium given by pill to the extent of three or four grains daily, or 
the tincture of conium to two fluidrachms daily, relieves the pain 
more effectively than opium, without so much disturbance of the 
digestive organs. Use as a lotion to the open ulcer the following : 

Chlorate of potassa, 1 drachm. 

Water, 12 ounces. 

Cancer is progressive, and in the great majority of cases incura- 
ble. The disease consists in a tendency to perverted growth in the 
different parts of the system ; and medicine knows no certain way to 
moderate or change that tendency, nor to get rid effectu? v ^y of the 



SCROFULA. 99 

result. Should the tumor be cut away, the tendency remains, and 
the tumor will grow again in the same part or another. 

Because physicians give so little encouragement in cases of 
cancer, the afflicted listen readily to professed cancer-curers, who 
of course promise any thing, and who can refer to any number of 
persons whose lives they have saved. Often the appearances in 
these cases are such as to impose upon intelligent persons, but, it 
will be generally sufficient to note that, though these persons may 
have cured something, there is no evidence but their own assertion 
that it was cancer. 

For a more particular account of cancer, see diseases of the parts 
it commonly affects. 

SCROFULA. 

Scrofula is rather a generally diseased state of all the parts of 
the body than a definite malady of regular course. This condition 
of the system is acquired by the children of the poor in great cities, 
living in cellars, and up "filthy alleys, never breathing the pure air, 
having always poor and insufficient food, exposed to the vicissitudes 
of changeable climates, and inheriting the enfeebled organs of 
drunken parents, or, worse still, a syphilitic taint. This condition 
is also developed in the children of the rich, overindulged in diet, 
late hours, etc. Certain pathologists have held that syphilis is always 
the cause of scrofula ; that it is a lingering manifestation of the 
syphilitic taint, holding on through generations that have outlived 
all the better-recognized appearances of syphilis. Scrofula is hered- 
itary, in so far that scrofulous parents can scarcely have healthy 
children ; but, on the other hand, the condition is induced by the 
causes named above in the children of those who themselves were 
free from it. 

Feeble development in every possible sense is the first general 
sign of the scrofulous condition. At twenty, a boy will have the 
size and general development proper to fifteen, and yet will be 
without the more buoyant characteristics of boyhood. If the child 
attain his proper height, there will be default of other growth, that 
should keep pace with growth in that direction. His spine is fee- 
ble, and curves. He perhaps had rickets in infancy. He is pigeon- 
breasted. All this is the result of languid performance of the sev- 
eral functions of digestion and assimilation. Intellectual inaptitude 
is usually as marked as physical debility. 

In scrofulous infants there is a tendency to the occurrence of un- 
manageable skin-diseases, sore mouths, gatherings in the ear, colds 
in the h^ad ; and, as the child grows older, the glands in the neck 



100 DISEASES OF THE GENERAL SYSTEM. 

swell, and sometimes present great masses at either side of the jaw. 
If these form abscesses and ulcerate, the ulcers are indolent, un- 
healthy, and hard to cure. " White swellings," or scrofulous inflam- 
mation of the joints, occur in this period. In a still later stage of its 
development, scrofula appears as a visceral disease, inducing in 
women chronic inflammation of the womb, and in both sexes 
chronic inflammation of the lungs, and the deposit of tubercles in 
the lungs, in the abdomen (causing tubercular peritonitis), and in the 
brain. It is of practical importance to distinguish the cases in 
which diseases are induced by the scrofulous state, for in these the 
cure will be more readily effected by attention to this condition. 

The point of greatest importance, in the treatment of scrofula, 
is to change the mode of life. Make sure that the patient has good 
food, of a nutritious character, and that is easy to digest ; that he 
breathes pure air, lives in the light and the sunshine, uses the warm 
bath freely, takes moderate exercise, sleeps at regular hours, but 
not too long, and is not worked too hard. Without attention to 
these points, all treatment would be vain. 

Medicine is only an adjunct. It must be such as will further the 
objects of the above treatment, in assisting to make healthy blood 
and a healthy nervous system. Iron and iodine are the two great 
agents, and the best preparation is the combination of these in the 
syrup of the iodide of iron. Give a child three teaspoonfuls of this 
a day for months together. Occasionally there will be encountered 
a scrofulous system that cannot endure iodine. In such cases, use 
the carbonate of iron in pills of three grains each. Give three to 
six or even twelve pills a day. Alternate this with the use of the 
liquor potassae arsenitis, given in doses (to an adult) of three drops 
a day for a week. Give a child of twelve one drop three times a 
day. 

INFLAMMATION. 

Inflammation, as it occurs in the various organs and parts of the 
body, has differences mainly due to the differences in the several tis- 
sues, but there are certain features common alike to all inflammations ; 
and it is this group of associated symptoms, constituting a morbid 
process rather than a disease, that we consider in this place. 

The symptoms are, first, local disturbances of vital action in the 
part affected. If the part is visible, it will be seen to be unusually 
red, from the presence of more than the natural quantity of blood. 
From the same cause there will be pain and increased heat, and a 
change of function, ending in its impairment. Secondly, as the re- 
sult of these disturbances of normal action, there is fever. 



INFLAMMATION. 101 

The redness may vary from light scarlet to dark purple ; in com- 
mon inflammation the redness is sometimes diffused, and gradually 
lost in the surrounding structures, while at other times it is abruptly 
circumscribed. Pain varies with the seat of the inflammation; 
thus it is tingling in the skin; throbbing in the tissue beneath 
the skin; sharp and cutting in pleurisy; sore, dull, and op- 
pressing in inflammation of the chest, stomach, or kidneys; 
pain is more severe generally in proportion to the unyielding 
character of the part — as in bone or ligament. Heat is most remarka- 
ble in parts the more distant from the heart — as in the extremities. 
Swelling is most marked in the loosest structures — as in the lips, 
cheeks, etc. Functions are impaired, as shown by increased sensi- 
bility and tenderness, and by the alteration or arrest of secretions. 

These symptoms may be either acute, that is, active and rapid in 
their course ; or chronic, that is, passive and slow in progress. In- 
flammation is also much modified by the condition of the constitu- 
tional powers; thus, it may be attended with signs of debility, 
constituting what is termed low inflammation ; or it may be attended 
with signs of increased force in the circulation, indicating an opposite 
condition of the system. 

These differences are dependent upon the causes — for the disease 
may be excited by actual increase in the force with which the heart 
acts, or it may depend upon a decrease in the resistance which the 
smaller vessels oppose to the blood-current, making the force of the 
heart's action relatively greater. 

Too full a diet, particularly too free a use of fermented liquors, 
is a predisposing cause. All causes which check habitual discharges, 
whether artificial or natural, especially the secretion by the skin, 
and all causes which considerably increase the force of the circula- 
tion, predispose to inflammation ; and, if applied suddenly and to a 
great degree, may act as exciting causes. Whatever increases the 
impetus of the blood toward the part may become a cause, and all 
mechanical and chemical irritants are well known frequently to pro- 
duce it ; such are heat, sudden changes of temperature, the action 
of strong acids, alkalies, metallic salts, acrid vapors, acrid vegetable 
oils, bruises, wounds, etc. Vicissitudes of weather are a common 
cause. 

In all cases of acute inflammation situated externally, the first 
circumstance to be attended to is, the removal of all such excitino- 
causes as may happen to present themselves. If the irritation of a 
splinter of wood, bone, etc., for example, were to excite inflamma- 
tion, every one would immediately see the propriety of removing it, 
and such a course must be adopted with every kind of mechanical 



102 DISEASES OF THE GENERAL SYSTEM. 

or chemical irritant present. After this is done, it will be necessary 
to moderate the increased action of the arterial vessels, thus lessen- 
ing the velocity of the blood's motion toward the inflamed part, and 
to increase the secretions, by means of blood-letting, purgatives, 
antimonial and cooling diaphoretic medicines, cold lotions, a spare 
diet, rest, and a relaxed, easy position of the part inflamed. 

The whole body, but more especially the inflamed part, must be 
preserved in as complete a state of rest as possible ; and, in inflam- 
mation of the limbs, a proper position is highly necessary. They 
ought not to be allowed to remain in a dependent position, but be 
constantly supported in one that is elevated and easy, so long as the 
inflammation is at all violent. 

The diet must be spare and low, all spirituous and fermented 
liquors and animal food being avoided for the first two or three days, 
or until the acute symptoms have passed away. Watery, cooling, 
mucilaginous drinks are highly proper and useful, and the best of 
such fluids are whey, butter-milk, barley-water, water-gruel, and de- 
coctions of dried fruits, as figs, etc. 

The medical treatment must meet the indications of lessening 
the violence of the heart's action, and relieving the oppression of the 
inflamed part or organ, and restoring the secretions. Blood-letting is 
often necessary in the young and vigorous, and in the vast majority 
of cases this may be local, and the blood be drawn by leeches. 
Opium will quiet the action of the heart, and tartar-emetic, acting 
as a depressant of the vital functions, generally will do the same. 

Chronic inflammation depends less upon the violence with which 
the heart acts than upon the reduced power of the nerves that control 
the action of the lesser blood-vessels. It needs, therefore, a tonic or 
stimulant treatment. 

There are certain terminations, or effects, of inflammation, which 
are denominated — 1. Resolution, or recovery, the inflammation en- 
tirely subsiding without leaving any alteration in the part affected ; 
2. Suppuration, or the formation of pus, or " matter ;" 3. Ulcera- 
tion ; 4. Mortification. 

When suppuration takes place, the pain and redness for the 
most part abate, the temperature falls nearer to the healthy degree, 
and the throbbing becomes more sensible. A conical eminence, or 
pointing, as it is termed, takes place at some part of the tumor, 
generally near its middle. In this situation, a whitish or yellowish 
appearance is generally observable, instead of a deep red, which is 
previously apparent, and fluctuation of a fluid underneath may be 
discovered on a careful examination with the fingers. 

Mortification results from intense inflammation in debilitated or 






RHEUMATISM. 103 

unhealthy constitutions; depression of vital energy, as in scurvy, 
typhus fevers, etc. ; obstruction to the circulation in a part or organ, 
as in rupture or inflammation of the large vessels of a limb, or 
under certain changes which take place in the arteries of persons 
advanced in years ; from external injuries, as bruises, spent balls, 
powerful chemical agents ; extremes of heat or cold ; some poison- 
ous substances, as spurred rye (ergot), or the poison of venomous 
reptiles ; impure air, as in overcrowded hospitals, producing " hos- 
pital gangrene." 

It is indicated, 1st, by change of color, from the redness of inflam- 
mation, or the natural hue, to livid, violet, purple, and black ; 2d, 
by falling of the temperature of the part ; 3d, by the subsidence 
of pain in the part itself, while it is augmented in the surrounding 
structures ; lastly, the part loses its consistence, becomes soft, and 
blisters form, containing fluid of a dark color and offensive odor. 

These are the principal characters of mortification of external 
parts. When it takes place in the internal organs, its existence can 
only be inferred from the rapid and total cessation of the signs of 
inflammation, with symptoms of increasing prostration or sinking ; 
viz., feeble pulse, cold skin, delirium, stupor. 

When external mortification is complete, a line of demarcation 
will be established between it and the sound parts in those cases 
where there is sufficient constitutional vigor to cast off the dead 
portion. Ulceration will take place on the surface, and the mortified 
portion will be gradually, as it were, amputated. In this manner a 
whole limb may be cast off, or an extensive portion of skin ; or, 
by dividing large vessels, it may cause fatal haemorrhage. 

In all cases of mortification, the constitution must be supported 
by tonics, of which quinine is, in all cases, the most to be relied 
upon. The diet must be nourishing, but care must be taken not to 
overload the stomach. A certain quantity of good wine, propor- 
tioned to the patient's strength and habits, and the symptoms of 
the complaint, is proper. Broiled mutton or lamb-chops, and fresh 
eggs lightly boiled, are very suitable ; and water, impregnated with 
carbonic-acid gas, must be taken as the common drink. This acid 
gas is sometimes of the highest efficacy in this class of cases. 

RHEUMATISM. 

This is divided practically into three classes : 1. Acute rheuma- 
tism ; 2. Chronic rheumatism ; 3. Rheumatic gout. 

Acute rheumatism commences as fever does, with languor, chilli- 
ness, thirst, restlessness, and a quick pulse ; there is also a sense of 
8 



104 DISEASES OF THE GENERAL SYSTEM. 

weight, coldness of the limbs, and confined bowels. There is a foul 
tongue, the urine is high-colored and turbid, the perspiration is pro- 
fuse and sour-smelling, and there is more or less of wandering pain in 
the limbs. Doubt as to the character of the disease will soon be 
solved by the increasing severity of this pain, and, in the course of 
a few hours, it will fix on one or more of the large joints ; all the ap- 
pearances of the most active inflammation will follow; the joints 
attacked will be hot, red, swollen, and exquisitely sensitive, so that the 
pressure of bedclothes, or the movement communicated by the jar- 
ring of the room, will cause distress. The pain is frequently transi- 
tory, and apt to shift from joint to joint, leaving the part previously 
occupied swollen, red, and extremely tender to the touch. 

Recognize acute rheumatism, therefore, by the concurrence of all 
these symptoms : 

1. There is fever, but it has an active, restless, tormented, impa- 
tient, and not the depressed, submissive, appearance of fever simply. 

2. Perspiration is profuse, and has a sour smell. 

3. Tongue is coated but moist. 

4. Bowels are not free, and what passes is offensive, and darker 
in color than is natural. 

5. There is great pain, especially on any attempt to move. 

6. The urine is scanty, more colored than usual, and deposits a 
sediment in the vessel. 

7. The pulse is full, bounding, and accelerated. 

8. No headache or delirium ; the mind is clear, but, as pain pre- 
vents sleep, the invalid becomes irritable. 

Fever may so distinctly precede all the evidently rheumatic 
symptoms as to deceive any one for a time. 

This is a disease that should be treated promptly and actively at 
once ; for, if not controlled or somewhat subdued within five days, 
it is apt to affect the heart, and thus endanger life. 

Give a purge as soon as the disease is recognized, and encourage 
to further activity all the evacuations. Give at night five grains of 
calomel, with one grain of opium, to be followed in the morning 
by- 

Powdered rhubarb, 3 scruple. 

Tartrate of soda and potassa, . . . . . . -£■ drachm. 

Water, 1 ounce. 

Keep the patient in bed in a warm room, and let him take, once 
in four hours, a tablespoonful of the following mixture : 

Nitrate of potash, £ ounce. 

Tincture of cimicifuga, . • 2 drachms. 

Water, 6 ounces. 



chronic rheumatism:. 105 

Give at the same time Rochelle salts, an ounce a day, in divided 
doses dissolved in water. 

While the pain continues, give a grain of opium every night at 
bedtime, with or without a grain of calomel. Attend at the same 
time to the joints. Use the following mixture : 

Carbonate of potash, 6 drachms. 

Decoction of poppies, 10 ounces. 

Glycerine, 2 ounces. 

Apply a piece of flannel, soaked in this, to the painful joint, under 
hot cloths. If the pain continue exceedingly severe, apply half a 
dozen leeches. 

No hearty food should be taken during the four or five days in 
which this treatment is necessary. 

As the pains abate their violence somewhat, test the urine with 
a piece of blue litmus-paper. If this is changed to red, continue the 
use of the nitre ; if not, take only half the quantity, and in two or 
three days discontinue it. There may, in some cases, be left wan- 
dering pains, coming on occasionally at night, and there will be need 
to recur, for a dose now and then, to the nitre. Having discon- 
tinued the nitre, take a teaspoonful, every three hours, of the follow- 
ing mixture : 

Decoction of cinchona, 4 ounces. 

Tincture of chnicifuga, 1-J- ounce. 

Muriate of ammonia, 5 drachms. 

CHRONIC RHEUMATISM. 

Chronic rheumatism is attended with tittle or no fever or inflam- 
mation, the chief symptoms being pain and swelling in the large 
joints and in the course of certain muscles. 

It becomes fixed most frequently in the loins, hip, knee, and 
ankles, but every large joint is liable to its attacks. The general 
heat of the body seldom exceeds its natural temperature, and the 
pulse is rarely quicker than eighty strokes in a minute; the joints 
are swollen, but not to so great a degree as in the acute form, be- 
ing of a pale hue, cold and stiff, roused with difficulty to perspira- 
tion, and always comforted by the application of warmth. 

Chronic rheumatism may follow the acute, but seldom does ; more 
commonly it occurs in those who have never had the acute, in older 
persons, or in the less vigorous, or more careful. It depends upon 
the same poison in the system that causes the acute ; but in the 
chronic this poison is present in smaller quantities. The obstinacy of 
this form depends upon the fact that the disease is kept up by the 



106 DISEASES OF THE GENERAL SYSTEM.. 

state of the digestive organs, and thus medicines given to carry the 
poison out of the system often prove useless, because the poison 
is made as fast as it is carried out. Pains in the lower part of the 
back, lumbago, pains higher in the back, pains along the course of 
the ribs, dull pains over the whole head in bad weather, stiff neck, 
are all so many manifestations of chronic rheumatism. Pains through 
the body, running from the pit of the stomach to the spine, and felt 
acutely on taking cold, are usually due to rheumatism of the dia- 
phragm. As any or all of these pains grow severe, use, for a day or 
two, the nitre mixture given above, and then for several days the 
cinchona. It is hopeless to attempt any thorough cure of this dis- 
ease, without proper attention to the derangement of the digestive 
organs that is always present (see Dyspepsia) ; but the cinchona 
mixture will meet in a certain degree both troubles. In using any 
other remedies for the derangement of the stomach, the following 
will control the rheumatic pain : 

Tincture of eimicifuga, twenty to fifty drops, three times a day. 

This is the blacksnake-root, and those who live in the country may 
prepare it for their own use. The following is effective in obstinate 

cases : 

Powdered guiacum, 
Precipitated sulphur, 
Carbonate of magnesia, 
Carbonate of soda ; of each, one ounce. 
Mix — take a teaspoonful of this in water three times a day. 

Occasionally the pains of chronic rheumatism hold on with great 
obstinacy. In such cases, it is always probable that a syphilitic 
taint modifies the disease, especially if the pains follow the course 
of the bones, rather than leap from joint to joint. 

Iodide of potassium is almost a specific in these suspicious cases, 
and therefore, if other means fail, it should be tried in doses of five to 
ten grains, thrice a day. In violent pains of the elbow, and other 
joints, aggravated at night, it is sometimes attended with complete 
success. 

Rheumatic gout is rheumatism in gouty subjects. The gouty 
tendency locates and gives peculiar character to the new disease. 
Treatment exclusively directed at the rheumatism will fail. Both 
diseases must be treated at once. "When this affection has resisted 
all plans of treatment for rheumatism, it will often give way imme- 
diately to treatment proper for gout ; as the rheumatism, associated 
with syphilitic taint, is cured by the treatment for syphilis. 

If, therefore, rheumatism that affects particularly the small joints 
is very obstinate, make the diet as nearly vegetable as possible ; and, 



GOUT. 107 

without discontinuing the rheumatic treatment, give of the following 
mixture one tablespoonful three times a day. 

Vinegar of colchicum, . . . . . . .2 drachms. 

Diluted hydrochloric acid, 40 drops. 

Water, 3 ounces. 



GOUT. 

Gout is a disease whose natural seat is the foot, but it affects 
other parts also ; and from this fact, and some other peculiarities in 
its appearance, it has been classed into the regular and irregular 
forms. Although a fit of the gout is an acute disease, and may pass 
through all its stages, and disappear as rapidly as acute diseases 
in general do, yet gout is in a certain sense always chronic ; an at- 
tack may at any day be brought on by neglect of the rules laid 
down for the guidance of persons who suffer from the malady. 

Gout sometimes comes on very suddenly, but, in general, is pre- 
ceded by various symptoms indicating a want of vigor in different 
parts of the body. The patient is incapable of his usual exertions, 
either of mind or body ; becomes languid, listless, and subject to 
slight feverish attacks, especially in the evening ; he complains of 
pains in the head, coldness of the feet and hands, impaired appetite, 
flatulency, heart-burn, spasms of the stomach, and the usual symp- 
toms of indigestion. He is oppressed with heaviness after meals, 
and a disturbed, unrefreshing sleep ensues. The bowels are seldom 
regular, being either constipated or too much relaxed, the mind at 
this period being generally irritable, anxious, and alarmed at the 
least appearance of danger. A deficiency of perspiration in the feet 
also, with a distended state of their veins, cramps, and numbness of 
the feet and legs, and other strange sensations, often presage the 
approaching fit. The duration of these symptoms, previous to the 
fit, is various ; sometimes only a day or two, at other times many 
weeks. 

Commonly the sufferer is awakened in the night by the full on- 
set of the disease, in the form of severe pain in the foot, with a sen- 
sation as if hot water were poured on the part. It sometimes ex- 
tends itself over all the bones of the toes, and forepart of the foot, 
resembling the pain occasioned by the tension oi laceration of a 
membrane. Cold shivering is felt at the commencement of the 
pain, which is succeeded by heat and other symptoms of fever. 
The pain and fever increase, with much restlessness, till about the 
middle of the succeeding night ; after which they gradually abate, 
and, in the most favorable cases, there is little either of pain or fever 



108 DISEASES OF THE GENERAL SYSTEM. 

for twenty-four hours after their first appearance. The patient, so 
soon as he obtains some relief from pain, generally falls asleep, a 
gentle sweat comes on, and the part which the pain occupied be- 
comes red and swollen. In most cases, however, the fit is not over, 
for the pain and fever return on the succeeding night with less vio- 
lence, and continue to do so for several nights, becoming less severe 
till they cease. 

Such is a simple fit of acute gout. But it often happens that, 
after the pain has abated in one foot, it attacks the other, where it 
runs the same course ; and, in those who have labored under re- 
peated attacks of the disease, the foot first attacked is often seized 
a second time, as the pain in the other subsides, which is again at- 
tacked in its turn, and they are thus alternately affected for a con- 
siderable length of time. In other cases, it seizes on both feet at 
the same time. After frequent returns, it begins to seize upon the 
joints of the hand, and at length the larger joints. When the gouty 
tendency is very great, almost every joint of the body suffers, the 
pain when it leaves one immediately fixing in another. 

In strong people, the whole fit is generally finished in about 
fourteen days. In the aged, and those who have been long subject 
to gout, it generally lasts about two months, and in those who are 
much debilitated, either by age or the long continuance of the dis- 
ease, till the summer heats set in. In the first attacks, the joints 
soon recover their strength and suppleness ; but, after the disease 
has recurred frequently, and the fits are long protracted, they re- 
main weak and stiff, and at length lose all motion. 

The above are the symptoms of regular gout. 

Irregular gout is the disease of a weakly or debilitated constitu- 
tion. Here the inflammation and pain are more slight, irregular, 
and wandering, than in the acute ; there is only faint redness of the 
affected joint, or no change at all of the natural appearance of the 
surface ; much permanent distention of parts, or continued swelling, 
with impaired moving power, and no critical indications of the 
disease terminating. The symptoms are always accompanied with 
those of impaired digestion; this form of gout is not essentially 
different from what is called retrocedent gout, where the diseased 
action affects the stomach, heart, or brain. The cause of gout is 
the insufficiency of the bodily excretions, and more particularly the 
failure of the kidneys to perform their whole office. In health there 
is a certain proportion between the amount of what is taken into 
the system, as food, and what is rejected, and passes out by the 
bowels, skin, lungs, and kidneys. Natural appetite will always pre- 
vent our taking more food than can be acted upon by the system, 



GOVT. 109 

and an active life will keep the excretions free, and save us from the 
results of small errors ; therefore, persons who live as they ought 
with regard to exercise, and take no more food than Nature 
prompts, never have the gout. On the contrary, it is the disease 
of those who indulge in great dinners, and take their exercise in 
that travelling arm-chair a nicely-cushioned carriage. Men who 
have robust constitutions, as the result of active early life, but who 
live more lazily as they come to middle age, and who stimulate a 
•nagging appetite with all the devices of cookery, and who, more- 
over, use wine freely, are the victims in the great majority of cases. 
Eating freely, and not digesting well, and, above all, not getting 
rid of the excess, they form in their systems the poison that finally 
causes gout. Gout appears sometimes in the poor, and feeble, and 
in the pauper-hospitals, but this does not furnish any ground against 
the above account of its origin. In these persons, their confinement 
to bed, or to hospital wards, is analogous, in some degree, to the 
lazy life of the other class, and even hospital diet is often too much 
for their digestive powers; these as a rule have irregular gout, 
when they have any. 

From this it follows that the true cure of gout is the reestab- 
lishment of the proper relation between what is taken into the body 
and what passes out. There is no other absolute cure, but all the 
gout specifics are merely temporary expedients. Colchicum, used 
for ages as an effective remedy, certainly possesses specific powers 
in relieving the pain of this disease, and, under judicious manage- 
ment, is a medicine of great value ; but, if used frequently and in 
large doses, as a principal means of removing the malady, it can 
never fail of proving highly and permanently injurious. Its good 
and bad effects may be stated in a few words. When it is used in 
small doses, occasionally repeated, in conjunction with suitable 
purgatives and alteratives, it frequently materially assists the full 
and efficient operation of those medicines, and is of great service in 
relieving the pain of the disease, without being followed by any 
subsequent injury. But if, on the other hand, it be employed in 
considerable doses, freely repeated, as a chief means of cure, the 
practice is as destructive in effect as it is bad in principle ; for al- 
though in first using it the patient finds its operation to be most 
pleasing and soothing, yet, in this way of employing it, it soon 
grows less and less effectual in relieving the fits, while, from its. in- 
jurious influence on the stomach and nerves, it engenders so great 
a degree of debility in them, as leads to a more speedy return of 
subsequent paroxysms, which also become of a more severe and 
intractable character. Thus the unhappy victim of an apparently 



HO DISEASES OF THE GENERAL SYSTEM. 

valuable but delusive remedy finds, often when too late, that he 
has been trusting to that which, in giving him present relief, has 
robbed him of future comfort, by entailing on him excessive and 
permanent debility of the stomach, nerves, and general system, and 
by inducing a state of chronic gout from which he is scarcely ever 
free. 

In the acute attack, begin the treatment of gout by attention to 
the bowels and kidneys — at the same time that specifics are given. 
Use the following pill : 

Calomel, 6 grains. 

Purified aloes, 5 grains. 

Acetic extract of colchicum, 5 grains. 

Powder of ipecac, 10 grains. 

Mix, and make ten pills. 

Take two pills every fourth hour, and, after three or four doses 
have been taken, give a draught of 10 grains of sulphur and 10 
grains of. sulphate of potash in half a tumblerful of water. When 
this medicine has acted freely, the pain will be somewhat less. Give 
the first, then, less freely — one in five or six hours, and at the same 
time give three times a day 10 grains of the iodide of potassium dis- 
solved in sufficient water. Should the malady not yield to this treat- 
ment, give, two or three times a day, one of the following pills : 

Sulphate of quinine, 30 grains. 

Extract of digitalis, 5 grains. 

Acetic extract of colchicum, 10 grains. 

Mix, and make ten pills. 

Should the disease still hold out, it is better to make no further 
effort to subdue it, except by the regular rational treatment of re- 
storing the proportion between absorption and excretion. Some 
very distinguished physicians, among them Trousseau of Paris, 
have even recently held that it was dangerous to attempt to modify 
the paroxysm of regular gout, lest the violence of the disease should 
fall on some part less able to endure it than the foot. Make no ap- 
plication to the foot, but relieve pain by the use of the acetate of 
morphia. Dissolve 1 grain in 1 oz. of water, and begin with a tea- 
spoonful, giving as much more as may be necessary to soothe. 

Upon the subsidence of a paroxysm the treatment must be di- 
rected to preventing a recurrence. In this, the treatment, if persist- 
ently and patiently followed up, is one -of the certainties of medicine. 
No man need have the second fit of gout if he will adhere with ordi- 
nary firmness to such rules of living as naturally flow from what we 



GOUT. HI 

have said as to the cause of gout. Relinquish entirely the use of 
colchicum. Let the "bowels be kept free, the kidneys active, and let 
plain food be used within the promptings of natural appetite, rather 
than to have appetite stimulated by culinary contrivance. Use 
freely of some saline mineral water — Congress water or the Get- 
tysburg water is quite equal to any of the European waters in 
their effect. Dine on a single dish, and use no malt liquor, and but 
little of any sort. 

In irregular gout the pain is less positively confined to the foot, 
but wanders somewhat, and is peculiarly liable to assail great organs, 
as the stomach, the heart, and the brain. In these cases the disease 
yields, as in the others, to the treatment that carries the poison out 
of the system, but it will also be necessary to take more active meas- 
ures against the immediate paroxysm. These measures consist in 
the application of heat to the feet in all cases, with a view to excite 
the manifestation of the disease there. If the brain suffers, apply 
cold to the head ; if the heart or stomach, apply to the surface a 
mixture of equal parts of tincture of aconite and chloroform. In 
these latter cases, an ounce or two of brandy and 30 drops of lauda- 
num may be given, if the paroxysm is violent ; or the compound 
spirit of ether may be given in drachm-doses, repeated at short in- 
tervals, as the occasion seems to require. 

Remember always that, whatever may be the form which gout 
assumes, it is certainly connected with disorder of the digestive or- 
gans, and in no disease is the preventive management productive 
of more benefit. The primary object, should there exist a predispo- 
sition to the disease, is to withhold all redundance of nutrition ; but 
at the same time to sustain the vigor, and to avert as much as pos- 
sible any tendency to inflammatory excitement. Too spare diet and 
excessive or fatiguing bodily exercise are not only unnecessary, but 
they often prove as injurious as the opposite extreme. The object 
is to prevent plethora, and to obviate it if it display itself. To pre- 
vent plethora, every tendency to fulness from diet must be shunned ; 
animal food should be moderately taken, and all fermented liquors 
left alone, or used quite sparingly. 

It is of the utmost importance to commence the renewal of the 
movements of the affected joints as early as possible after the pain 
is allayed. Their strength and flexibility depend solely on the early 
renewal of motion : on the contrary, rest tends to retard the restora- 
tion of the affected parts to complete health. They remain painful 
and stiff, and resist every movement which is attempted ; the more 
motion is cultivated, the sooner are the limbs restored to their natu- 
ral functions. Their exercise recovers the balance of the circulation. 



112 DISEASES OF THE GENERAL SYSTEM. 

prevents effusion, aids absorption, and consequently favors flexi- 
bility. If rest be indulged, from the dread of pain, the joints and 
the parts surrounding them become rigid, contracted, and their free 
action permanently impaired, while the muscles waste and lose their 
power of contracting. 

SYPHILIS. 

Syphilis, as a disease of the general system, results from the ab- 
sorption of poison from a sore on the genital parts, or it is inherited 
from syphilitic parents, or it is communicated to a child by a wet- 
nurse, or to a wet-nurse by the child. In these cases the manifesta- 
tions of the disease are called secondary and tertiary ; the primary 
manifestation being the original sore communicated by direct con- 
tact with one having the disease. 

Of the primary syphilitic sore called a chancre, occurring on the 
genital parts, there are two varieties — the soft chancre and the in- 
durated. The soft chancre is a local disease at first, and, if treated 
within four days of its occurrence, is cured completely ; the hard 
chancre is less certainly curable. The indurated chancre is known 
by its hard base, sharp edges, and the inflamed circle around it. 
These indicate the action of the specific inflammation in the tissues 
beneath the sore. In the soft chancre there is none of this, only the 
appearance of a simple superficial sore, with a thin gray pus over it. 

Secondary symptoms affect — 

1. The lymphatic glands, causing bubo. 

2. The mucous membranes, causing ulcerated sore throat, ulcers 
in the larynx, etc. 

3. The skin, causing ulcers and eruptions. 

4. The eye, causing inflammation of the iris. 
Tertiary symptoms affect — 

1. The bones, causing tumors, and decay and death of the bone. 

2. The viscera. 

Secondary symptoms, occurring in the persons of those whose 
systems have been contaminated by the poison of the primary sore, 
are recognized without difficulty ; but, at another remove, the case 
is less easy, and it is often a very delicate point to determine 
whether sores on an infant, for instance, are syphilitic ; while ter- 
tiary symptoms, especially when the disease is hereditary, are laid to 
the score of rheumatism with much persistency. 

If the chancre has not been treated with such energy as to de- 
stroy, at the very commencement, its specific character, and thus pre- 
vent the poison altogether, the system will give evidence of the 
presence of the disease within a few weeks. There is a syphilitic 



SYPHILIS. 113 

fever, all the symptoms of which, however, may very likely pass 
with little notice, except the headache. This is obstinate, persistent, 
sometimes intermittent, and there is often pain in certain joints. 
Associated with the headache, in point of time, is an enlargement 
of the glands in the back of the neck, a sign almost constant. Fol- 
lowing these premonitions, in from thirty to forty days from the ap- 
pearance of the first sore, there are eruptions on the skin. These 
may assume any form ; they may be erythematous or pimply, pus- 
tules or vesicles ; the only positive sign, by which they can be 
known to be syphilitic, is their color. This has a coppery tint that 
is not only seen in the eruption, but in the scar it leaves. Unlike 
the eruptions of skin-diseases, for which they might ordinarily be 
mistaken, these eruptions cause no pain and no itching. On the scalp, 
there may be itching, but this will be because some other eruption is 
there mingled with the syphilitic. The eruption may dry away in 
scales, it may become scabby, or it may give rise to deep, tenacious, 
suppurating ulcers. Symmetry is a noteworthy characteristic of the 
eruption. At the point where there is a patch on one side of the body 
there will be one of similar shape and size on the other side. Eruptions 
of certain forms favor particular parts, as the inner side of the arms 
or thighs, the soles or palms, and the scalp. Generally these erup- 
tions are of chronic character. That form which favors the inner face 
of the upper limbs, as the inside of the bend of the elbow, is the 
commonest eruption, and some maintain that it is constant ; that it 
is always part of the manifestation of constitutional syphilis ; that, if 
this is not part of any eruption, that eruption cannot be due to syph- 
ilis. This comes early, often at the same time that the lymphatic 
glands are swollen. It may appear as early as three weeks, as late 
as four months, after infection. In addition to the points it chooses 
on the limbs, it appears on the breast, abdomen, and flanks ; very 
rarely in the face or neck. It is, at the commencement, of a rose 
color, but becomes coppery, just perceptibly elevated, disappears 
on pressure, and occurs in irregularly-rounded spots of variable size, 
that generally have a more or less distinct circular arrangement. 

The syphilitic sore-throat may be indicated by a uniform redness 
over the whole apparent surface of the palate and the tonsils, and 
a dryness and burning feeling, or by the same appearance in points 
that subsequently become elevated and ulcerate. If the voice be- 
come rough and hoarse, it is because the disease has attacked also 
the lining membrane of the larynx. In consequence no doubt of the 
extension of the disease, stricture of the oesophagus (the passage to 
the stomach) sometimes occurs. Stricture of the rectum is also an 
occasional result of syphilis. 



114 DISEASES OF THE GENERAL SYSTEM. 

The loss of the hair may occur at different periods in the disease, 
before any eruption, or much later ; sometimes the hair grows again, 
sometimes the baldness is permanent ; occasionally the nails fall also. 

Generally, the disease does not reach the tertiary stage, but dis- 
appears earlier, yielding to the curative influences of a proper mode 
of life, or to medical treatment ; but tertiary forms, when they occur, 
endanger life. They seldom occur before the sixth month, and may 
be delayed for ten or twenty years. 

The most usual appearance of the tertiary form of syphilis is in 
disease of the bones that induces changes. Hence, when it takes 
hold of the bones of the cranium, as often happens, it is very apt to 
prove fatal. When these pains are first felt, it may be in the head, 
the arm, or leg ; the part affected neither changes in size, color, nor 
temperature. The pain comes without known cause, is very deep, 
and is increased by pressure, is fixed and circumscribed, and becomes 
worse at night. At first, indeed, the pains are felt only during the 
night. The pain only indicates the change that is in progress in 
the bone, and which is yet imperceptible. The pains may last thus 
for two years, without apparent change in the part, but generally the 
effect is sooner seen. The syphilitic inflammation of the bone, thus 
begun, may directly destroy part of the bone, or may produce tumors 
of the class called " nodes," and operation for cutting away part of 
the bone often becomes necessary. 

So long as a man has syphilis in the secondary stage, the child 
he begets will inherit the disease. It is not necessary that there 
should be obvious manifestations of the disease upon the father, but 
it must be in the secondary stage. Should there have been tertiary 
manifestations, his child will not be syphilitic, but scrofulous. 

Usually, an infant inheriting syphilis is born healthy-looking, 
but sometimes the skin is of a dull color, and the features have a 
pinched, sharp expression. Generally, within the first month, the 
disease comes on with trouble in the nostrils — " snuffles," cough, 
difficulty in sucking, dryness of the lips and mouth ; and superficial 
ulcerations follow about the mouth and throat. These parts, the 
buttocks, anus, and bends of the joints, become copper-colored, and 
crack, and the child wastes. Syphilitic disease of internal organs 
may destroy it. 

Treatment of a Chancre. — There is no proper antidote to 
the syphilitic poison, and the only chance to prevent infection of the 
system from a chancre is to destroy entirely, by corrosive agents, 
the specific character of the pus of this sore, and the tissues in its 
immediate neighborhood that are already contaminated, and from 
which the poison may be taken up by the system. Cauterization, 






SYPHILIS. 115 

in the view of Ricord, makes the chancre a simple sore. If there is 
a soft chancre, therefore, wash it thoroughly with a jet of water, and 
then apply enough freshly-made Vienna paste to cover it. Remove 
this after a minute, and apply a poultice, and afterward use freely, 
till the sore heals, the following wash : 

Hydrochloric acid, . . . . . . . 1 drachm. 

Water, 2 ounces. 

Mix. 

The nitrate of silver is not sufficiently powerful to destroy the 
tissue. Pure nitric acid may be used, but the Vienna paste is 
better. 

This local treatment will certainly prevent further effects, if 
adopted when the sore is not more than four days old. If the chan- 
cre be one with hard base, use exactly the same means, but in this 
case it is not certain that they prevent constitutional infection ; the 
chance that they may, should, howeyer, not be thrown away. This 
is the advice of Ricord, who, nevertheless, says this sort of chancre 
is inevitably followed by constitutional disease. 

Should there be inflammation of the part, with the sore, it will 
be necessary to reduce this before using the caustic. 

Keep the patient at rest if possible for some days. Enforce upon 
him the necessity of abstaining from the use of all malt or spirituous 
liquors — of using meat only once a day, and of keeping his bowels 
free by mild laxatives. 

Mercury may be used, when the system has been thus prepared, 
with every chance of realizing its best effects. 

Mercury, given at this time, will facilitate the healing of the sore ; 
and this is a real advantage, for the greater or less severity of sec- 
ondary symptoms,, should they come, seems to depend in a consid- 
erable degree upon the duration of the original chancre. Give the 
following pill : 

Corrosive chloride of mercury, 2 grains. 

Extract of guaiacum, 32 grains. 

Mix, and make 32 pills. 

Take one pill three times a day. If the chancre takes on an 
unhealthy appearance, and extends into new tissues, give iron : 

Tartrate of iron and potassa, 1 ounce. 

Water, / 6 ounces. 

Mix. Take a tablespoonful twice a day. 

Treatment of Secondary Symptoms. — Mercury can no longer 
be looked upon as an antidote to the syphilitic poison ; and, as the 



116 DISEASES OF THE GENERAL SYSTEM. 

belief that it was, was the origin of its universal and indiscriminate 
use in this disease, such use is no longer reasonable. Although 
mercury is not an infallible remedy, it is certainly often a useful and 
effective medicine; in certain states of the system it will conduce 
more directly to a cure than any other, while at other times it may 
do only harm. 

If the primary disease was treated with mercury, give iodide of 
potassium immediately on the appearance of secondary symptoms, 
in doses of 5 grains in water three times a day, acting on the 
bowels with an efficient dose of blue pill (10 grains). Should the 
treatment seem ineffective, after a few days vary it, by giving, twice 
a day for three days, one grain of calomel, or ten drops of the liquor 
arsenici et hydrargyri iodidi. Recommence afterward the use of the 
iodide of potassium, and it will be more effective. 

Should it be deemed desirable to attempt the treatment without 
mercury, put the patient on the free use of sarsaparilla, and a good 
diet, and give the following powder : 

Purified sulphur, . 1 drachm. 

Sulphuret of antimony, 5 grains. 

Nitrate of potash, 5 grains. 

Mix. 

This quantity is to be taken every day — half in the morning and 
half at night, and the medicine must be perseveringly used. 
Use as a gargle for the sore throat : 

Tincture of iodine, 1 drachm. 

Tincture of opium, 1 drachm. 

Water, 6 ounces. 

Gargle the throat several times a day. 

When, following a primary sore, there are tenderness in the groin 
and stiffness as the patient walks, a bubo is forming. Insist then on 
rest for the patient, and paint over the enlarged gland, night and 
morning, with a strong solution of iodine. This will, perhaps, pre- 
vent suppuration; but, should suppuration still seem inevitable, 
hasten it with warm applications. When matter is ready to be dis- 
charged, open the bubo with Vienna paste. Dress it with lint wet 
with a weak solution of sulphate of zinc. 

When the hair threatens to fall, cut it close, use warm baths, and 
apply the following liniment: equal parts of alcohol, cologne water, 
and castor-oil. 

Tertiary symptoms can only be controlled by the continued use 
of mercury, of which the best form is the corrosive chloride, which 



TUBERCULOSIS. 117 

should be given in doses of the twelfth to sixteenth part of a grain 
twice a day. Against the nocturnal pain, use opium, and avoid all 
exposure. 

For syphilitic disease in infants, use hydrarg. cum creta, two grains 
a day ; or, if the infant is very feeble, one grain continued for a fort- 
night ; upon stopping the mercury, give in syrup of sarsaparilla one 
grain a day of the iodide of potassium. 

TUBERCULOSIS. 

This word is employed to indicate a condition of the system in 
which there is a tendency to the deposit of tubercles in different 
organs. Commonly, the word tubercle is most heard in connection 
with disease of the lungs, and tubercular disease of the lungs occurs 
more frequently than other tubercular disease ; but tubercles are also 
deposited in the brain and in the intestines, especially in children, 
and may, indeed, be deposited in any organ urged to great functional 
activity. 

The matter of tubercles leaves the vessels as a portion of the mass 
of nutritive material conveyed to the part ; but it is, through the 
enfeebled vitality of the system, of so low a character that it is not 
assimilated, and remains in the condition in which it is deposited, 
acting much as a foreign body. Remaining in the part a certain 
time, it becomes a source of local disease by the irritation it excites. 
Thus in the brain it causes hydrocephalus, and in the abdomen tu- 
bercular peritonitis. Eventually it softens, as in the lungs ; sloughs, 
and is carried out of the system. As it has by its presence excited 
disease in much of the neighboring tissue, that also is destroyed with 
it. Thus a deposit of tubercles in the lungs leads to extensive de- 
struction of the delicate pulmonary tissue, and, if uncontrolled, will 
be fatal through this fact. 

All things that depress the vital energy, and modify the course 
of healthy nutrition, whether they act on the nervous system, or on 
the blood, tend to produce the state of the system in which tubercles 
occur. Scrofula or syphilis in parents, privation, exposure, resi- 
dence in unhealthy districts, disappointment, and anxiety, are all 
possible causes. 

If inflammation occur in those having the tubercular disease, the 
exudations are prone to be modified by it, and, instead of being 
those of ordinary inflammation, to consist of tuberculous matter. 
Especial care to guard against such accident is necessary in scrofu- 
lous subjects, and in all such equal care should be taken to improve 
the vital quality of the blood. 



118 DISEASES OF THE GENERAL SYSTEM. 



DIPHTHEEIA. 

This disease, like tBe, fevers, presents several varieties. There is 
a simple diphtheria, in which there is fever with sore-throat ; a croupy 
diphtheria, in which a membrane forms rapidly in the throat, and ex- 
tends to the larynx ; a form in which the trouble in the throat is 
ulcerative, and one in which it is malignantly intense in its onset, 
and is characterized by haemorrhage, not only from the throat, but 
from the stomach or bowels. In all there is always more or less 
membrane, but the second kind is the only one in which the mem- 
brane is the actual cause of death. In that variety it kills by suf- 
focation. Ranging, in severity, from the simple to the malignant 
varieties, the disease may resemble a mild fever, passing off after 
several days, or it may strike with terrific suddenness and kill in a 
few hours, sometimes the patient falling a victim to the constitution- 
al effect of the disease before it appears in the throat at all. 

There is general uneasiness, with perhaps intense headache and 
discomfort in the throat, and a swelling of the glands behind the 
jaw. Fever comes on, and there is difficulty in swallowing. Over 
the throat and tonsils there is a deep red, almost purplish color, and 
in two or three days a whitish membranous deposit. In the simple 
form of the disease matters continue this way for several days, when 
the throat clears up and the patient becomes convalescent. In 
the croupy variety, instead of disappearing, the membrane constantly 
increases, and invades the larynx, as the croupy, barking cough and 
whistling respiration will indicate. The ulcerative variety seems 
identical with the putrid sore-throat. The malignant is always 
fatal. It seems due to a deeper poison than the other varieties. 
Often there is very little local disease apparent, which may only be 
due to the fact that the disease has begun in the stomach, and kills 
before it gets up to the throat. This is apparently the explanation 
of the haemorrhages that occur in this form. 

Diphtheria in those who recover is sometimes followed by tem- 
porary paralysis. 

This disease has appeared to be contagious in some well-marked 
cases. 

Treatment.— Give an adult from the commencement twenty 
grains of chlorate of potassa, every three hours, and sponge the 
throat and tonsils thoroughly and effectively with a solution of 
nitrate of silver, one drachm to an ounce of water. If prostration 
come on, support with wine or brandy, and feed with beef-tea. This 
is the plan that promises generally the best results. Many physicians 



DIPHTHERIA. 119 

give calomel freely, and claim that a case is never lost where the 
system is brought under the influence of mercury. Tincture of the 
chloride of iron has proved effective. Give twenty drops every 
three hours. This may be given with the chlorate of potassa. Sul- 
phate of quinine may be given in doses of one grain every two or 
three hours. In the worst forms, with great prostration, the only 
hope is in the stimulants, the chloride of iron, wine and brandy, and 
the beef-tea. 



DISEASES OF THE CHEST AND RESPIRA- 
TORY ORGANS. 



CATARRH. 



There is a simple form of catarrh, the coryza of physicians, and 
this is one of the manifestations of a common cold, and is universally 
known as cold in the head (see Common Cold). There is another 
catarrh, however, that is of a malignant character. This is the ozsena 
of the doctors — this word signifying a stench. Any one familiar 
with the disease will recognize the propriety of the name. 

Malignant catarrh may be the result of many long-continued at- 
tacks of simple catarrh in scrofulous persons, and of ulceration of 
the inner part of the nose, however brought on by specific diseases. 

There are always uneasiness and a stuffed-up condition of the 
nose ; there are headache, and a profuse discharge of bad-smelling 
matter from the nose. This discharge sometimes dries inside the 
nose in flakes and crusts, and there rots, giving forth an odor worse 
than when it was fresh. 

The treatment must be local and general. The nose must be 
regularly syringed with warm water to keep it clean ; and then 
washed, also by means of a syringe, with strong liquor of chloride 
of lime — half an ounce of the lime to a tumblerful of water. Yapor 
of iodine may be inhaled with good effect. Throw a few drops of 
iodine on any thing hot enough to vaporize it, and draw the vapor 
through the nose. 

The general treatment should be cod-liver oil and iron. They 
may be taken together, in a mixture of four ounces of the oil with 
sixteen grains of the iodide of iron, so that every half-ounce dose of 
the oil will have two grains of the iron. Another form of iron that 
is very effective is the carbonate as prepared in Valet's mass. It 
may be taken in very large quantities, from eighteen to sixty grains 



INFLAMMATION OF LARYNX. 121 

a day. A good plan is to begin with six three-grain pills a day — 
and add a pill every day till ten are taken. This must be con- 
tinued for months. If there is any probability of syphilitic taint, 
give hydrargyrum cum creta in five-grain doses, once in three days, 
till its effect is seen. 

INFLAMMATION OF LARYNX. 

This disease is sudden in its invasion, and, if not controlled at 
once, is very dangerous, destroying life by suffocation, as it closes 
the air-passages. It begins as a sore-throat, but occasions a greater 
distress than the appearance in the throat would account for. Swal- 
lowing then becomes difficult, and the voice is affected. Ordinary 
sore-throat may hardly affect the voice ; but, as the larynx is the 
organ of the voice, its disease becomes peculiarly evident in this 
change. The voice becomes hoarse and croaking, or may fall to a 
scarcely-audible whisper. Breathing becomes difficult, and is forced 
and painful, and the cough has a ringing, high sound. Great tight- 
ness is also felt, and the breathing is still further impeded by a 
stringy, tenacious mucus. 

Exposure to cold is a common cause of this disease. Indeed, the 
sore-throat due to a common cold sometimes ends in this way, by 
extending into the larynx. Contact of irritating gases, as too 
strong ammonia, may also cause it, and it happens in children as the 
the result of swallowing, by mistake or otherwise, scalding water. 

Tkeatheistt. — Apply cups at the back of the neck, and on both 
sides of the neck, and leeches to the top of the breastbone — in an 
adult, at least twenty leeches ; in a child of five or six years, from 
two to six. At the same time, apply to the throat, and the whole 
front of the neck, water as hot as it can be borne. Give tartar- 
emetic, half a grain immediately, and keep the patient under the relax- 
ing influence of that medicine, by doses of an eighth to a quarter 
grain, once every half hour. Give also ten grains of calomel to 
an adult. 

If the disease continues severe, it may be necessary to open the 
windpipe, to save life, and this, of course, can be done only by a 
surgeon. 

CHRONIC LARYNGITIS. 

This occurs not as a consequence of the former, but as a result 
of syphilis, or tubercles. In the latter case, it is a form of consump- 
tion, and must be treated in the same way. In the former, the dis- 
ease only yields to treatment proper for the syphilis. (See those dis- 
eases.) 



122 DISEASES OF CHEST AND RESPIRATORY ORGANS. 



(EDEMA GLOTTIDIS. 

As one of the consequences of inflammation of the larynx, the 
membrane at the top of the glottis, at each side, becomes greatly 
swollen, dropsical in fact, and these swollen parts, meeting over the 
opening, close it and prevent the entrance of air. This, of course, 
will destroy life in very few minutes. By passing the finger down 
the throat, the offending cause may be felt in the puffy, expanded 
membrane. There is no remedy but to puncture this with a sharp 
instrument, and let out the water. This must be done, with little 
time lost in thinking about it. 

CROUP. 

This disease generally commences with catarrh and hoarseness ; 
or, perhaps, without any such premonitory symptoms, the patient is 
attacked (most frequently in the night) with difficulty of breathing, 
each respiration being attended with a peculiar shrill sound, some- 
what resembling the passage of wind through a horn or metallic 
tube. There is a short, dry cough, which has a peculiar barking 
sound, and is sometimes attended with expectoration of tube-like 
fragments of membrane. The voice is harsh and grating ; the pa- 
tient is feverish and restless ; the countenance distressed ; the pulse 
rapid. If not arrested, suffocation ensues : it may be in a few hours, 
or it may not prove fatal for several days. 

Constitutional predisposition, and the age of infancy, exposure 
to cold, or to a keen easterly wind, are the causes. Croupy cough 
neglected may terminate in croup, and there is but little hope in 
treatment, unless the disease is recognized early. For this reason, 
every disease that invades the larynx or glottis should be very closely 
scrutinized from its commencement. In general, very considerable 
heat of the surface is an early symptom of croup. In any disease, 
therefore, attended with increased heat, and marked by any change 
in the voice, and by a husky and hoarse cough, and a whistling res- 
piration, watch the interior of the throat for the characteristic sign 
of this most formidable disease, the false membrane. Remember, 
however, that though the sight of this membrane assures you of the 
nature of the disease in which it occurs, the disease may still be 
croup, though you fail to see any membrane. 

Treatment. — Put the patient in a hot bath. Give fifteen or 
twenty drops of ipecacuanha-wine in a little warm water every five 
minutes, until vomiting is produced. 

To a child over one year of age, a teaspoonful of ipecacuanha- 






INFLAMMATION OF THE LUNGS. 123 

wine, repeated every ten minutes, will not be too large a dose when 
given as an emetic. It is a safe remedy, as it will produce vomiting 
without the depression of the heart's action, which sometimes follows 
on the administration of antimonial wine, and which therefore ren- 
ders the latter a less safe medicine. 

While the patient is in the bath, apply a mustard-plaster to the 
front of the neck and upper part of the chest, and apply water 
nearly scalding on the throat, immediately under the chin, with a 
sponge. 

These means, if promptly employed, will generally arrest the 
most dangerous symptoms ; but, if the attack be severe, or if the 
symptoms do not yield, two or three leeches must be applied, care 
being taken that they bite over the bone of the upper part of the 
chest, as pressure to stop their bleeding cannot be used on the neck. 
The bleeding should be stopped by cold or pressure, as soon as the 
leeches come off. If, in the course of five or six hours after the re- 
moval of the leeches, the symptoms have not markedly diminished 
in severity ; if the cough and the breathing be still harsh and rough ; 
if there be no sound of moisture or phlegm with the cough, a blis- 
ter-plaster should be applied on the chest near or over the leech- 
bites. The plaster should remain on only two hours, and when re- 
moved a warm bread-and-water poultice should be applied to the 
surface. 

If the immediate inflammatory symptoms abate, give quinine, a 
grain an hour. Should the inflammatory symptoms not yield, get 
a doctor, if it is humanly possible. 

INFLAMMATION OF THE LUNGS. 

This is denoted by the occurrence, in an acute disease, of pain in 
the chest ; difficulty of breathing, alleviated by an erect position ; 
tumid, purple face or lips ; distressing cough ; a strong, hard, and 
frequent pulse ; pungent heat of skin, and fever. These symptoms 
vary considerably in different cases. The difficulty of breathing is 
the most constant symptom, and becomes considerable in all cases 
as the disease advances. The pain is sometimes peculiarly acute, 
and at other times heavy and dull, and it may be either in the right 
or left side, or under the breastbone, collar-bone, spine, or shoulder- 
blades. The cough is often very distressing, being in some cases 
dry, in others attended with spitting. The pulse is very hard and 
strong; the thirst considerable; the tongue often dry, white, and 
rough ; the urine scanty and high-colored, and there are an anxious 
expression and dusky hue of complexion. 



124 DISEASES OF CHEST AND RESPIRATORY ORGANS. 

When the determination of blood to the head is very great, and 
marked by stupor in the commencement of the disease, the symp- 
tom is extremely unfavorable. Delirium is likewise a very danger- 
ous symptom. 

Inflammation of the lungs may exist with little or no pain, when 
the real nature of the case may be known by the constant difficulty of 
breathing, painful cough, presence of fever, and sometimes by the 
nature of the expectoration. This has an appearance quite charac- 
teristic : it is like glue in its adhesiveness, and, when received into a 
flat and open vessel, unites into so viscous and tenacious a mass, 
that we may turn the vessel upside down without the expectorated 
matter being detached ; and if we shake the vessel its contents vi- 
brate like jelly, though in a less degree. But the color of the expec- 
toration is still more characteristic. It is prune-juice color, but may 
shade away to so light a hue as just to be tinged with lemon-color. 
It is never white. This will enable any one to distinguish that the 
disease is neither plemisy, nor inflammation of the heart, nor bron- 
chitis. In the two former, there is no expectoration. In the latter, 
the expectorated matter is white. 

Treatment. — When the fever, pungent heat of skin, pain, and 
difficulty of breathing, are urgent, in tolerably strong persons, espe- 
cially in the country, blood should be immediately drawn from the 
arm to the extent of twelve ounces. This will prove a remedy of 
great power. But, if the patient's constitution is weak and exhausted, 
and low fever is present, then bloodletting will do harm. If inflam- 
mation of the lungs has come on after extreme domestic anxiety and 
distress, whereby the general powers of the system have been prostra- 
ted, or in a weakly habit, or in old age, bloodletting should not be 
employed. Even should it, if used in these cases, seem temporarily 
beneficial, it will render the patient less able to endure the disease 
in its later stages. But, where it is not advisable to draw blood from 
the arm, it will nearly always be good, particularly in the young, to 
take some blood by leeches, or by cups applied effectively at the seat 
of the disease. Twelve leeches is a fully effective number. Counter- 
irritation is a remedy of great value. Place a blister over the dis- 
eased side, and get its full action ; and, when it is taken away, dress 
the surface with oiled silk. Or, if the subject is of too sensitive and 
irritable a temperament for the use of a blister, envelop the whole 
chest in a large warm poultice made of meal or bread. Renew this 
as it gets cold, but never take off one poultice till another is ready. 

Tartar-emetic is of great service in all inflammations of the chest. 
It is employed alone in these complaints by many French and 
Italian physicians. They have trusted maiuly to large doses of this 



PLEURISY. 125 

substance in such cases for many years past, and with admirable 
success. It is a medicine that may be used without either the bleed- 
ing or the counter-irritation. Commence in an adult with giving a 
tablespoonful of the following mixture, every two hours, in a teacup- 
ful of barley-water or tamarind-tea : 

Take of tartar-emetic, 12 grains. 

Water, 6 ounces. 

Syrup of saffron, 2 drachms. 

In general, the quantity of tartar-emetic ordered in this mixture 
should be increased three grains a day, till the patient takes twelve, 
fifteen, or twenty grains during the twenty-four hours ; the dose of 
the mixture being still a tablespoonful every two hours. If much 
tendency to sweating occurs, three or four drachms of the sweet 
spirit of nitre may be added to the mixture ; and, should there be 
much uneasiness and seeplessness, a drachm of tincture of opium 
may be mixed with it. The following are the usual effects of the 
medicine: the patient generally vomits after the second or third 
dose of the first mixture, and afterward it either acts on the' bowels, 
or produces no other sensible effect than that of mitigating quickly 
the symptoms of the disease. 

If there be loss of sleep, give at night one grain of opium with one 
grain of calomel ; or give ten grains of Dover's powder. 

It is hardly necessary to direct that the patient be kept in bed, 
in a room moderately warm and quiet. ISTo solid animal food should 
be taken, only barley-water and similar mixtures, unless the fever 
should assume the character of typhoid fever, when it will be neces- 
sary to sustain with beef-tea and wine. 



PLEUEISY. 

Pleurisy may be caused by exposure to cold, blows, falls, or any 
thing which gives rise to inflammation in other parts ; those of a full 
plethoric habit are chiefly subject to it. 

The early symptoms are generally cold chills, shivering-fits, and 
rigor, followed by acute pain in the side, a flushed countenance, dif- 
ficulty of breathing, dry cough, and full, hard, and frequent pulse. 

Pain is nearly always present, generally in a particular spot 
under one of the breasts, but sometimes at another part of the chest, 
or on the shoulder, the armpit, or under the collar-bone ; it is greatly 
increased by pressure, coughing, and deep inspiration ; the patient, 
therefore, breathes thick and short, suppresses coughing as much as 
possible, and fears to exert himself, or to lie down. Sometimes the 



126 DISEASES OF CHEST AND RESPIRATORY ORGANS. 

inflammation causes a sticking of the pleura, and adhesion of the 
membrane covering the lungs, and that which lines the chest ; at 
other times there is an effusion of fluid into the cavity. 

Teeatment. — Bleeding from the arm should be at dnce resorted 
to in a robust person, not in the aged nor in those enfeebled from 
any cause. Leeches, or cupping, and a warm poultice to the seat of 
pain ; a large blister after the latter comes off, if necessary ; a full 
dose of calomel (ten grains), and then tartar-emetic about every two 
hours, beginning with half a grain, and increasing it to two grains ; if 
this produces vomiting and purging, lessen the dose again, and add 
six drops of laudanum to each. When the. urgent symptoms are re- 
lieved, give hydrargyrum cum creta in three-grain doses every night, 
with small doses of opium, quarter to half a grain. The diet must 
be low, and perfect quiet maintained ; the temperature of the room 
kept up to about 60° Fahr., and the patient somewhat elevated in 
the bed. Should symptoms of exhaustion arise, the difficulty of 
breathing increase, and coma or delirium be threatened, recourse 
must be had to stimulants, such as beef-tea, with wine, or ammonia. 
Give five grains of the carbonate of ammonia in a mixture of three 
tablespoonfuls of water to one of brandy. Let a tablespoonful of 
this be taken every hour, or half hour. 

BRONCHITIS. 

This usually commences with the symptoms of a common cold, 
such as running at the nose and eyes, hoarseness, tickling in the 
throat, soreness or pain of the chest, oppression in breathing, and 
pains in the limbs and body.' The cough is accompanied by expec- 
toration of watery, transparent, and pale phlegm. At first the ex- 
pectoration is scanty ; it becomes more abundant, thick, and opaque, 
varying as the disease advances or continues long. There are more 
or less fever and constitutional disturbance, heat of skin, quickness 
of pulse, loss of appetite, furred tongue, costiveness of the bowels, 
scantiness of urine. 

Teeatment. — Bronchitis presents different degrees of severity, 
and its treatment must be modified accordingly. 

1. Slight or catarrhal. — The symptoms being little more than 
those of common cold, and the cough but trifling, will call for only 
simple diaphoretics (medicines to promote perspiration), followed by 
mild aperients if the bowels be costive. (See Catarrh.) 

2. Acute Bronchitis. — The symptoms are severe from the first, 
and rapid in their course. Mustard-poultices should be freely ap- 
plied over different parts of the chest. An emetic of ipecacuanha 



WHOOPING-COUGH. 127 

should be given. The emetic may be repeated at the end of twenty- 
four hours, if the symptoms have not decreased in severity. 

In adults of full habit, leeches should be applied on the front of 
the chest — from one dozen to three dozen, according to the severity 
of the symptoms. 

Chronic bronchitis may result from neglect of the above, but is 
more generally quite another disease, occurring more in feeble per- 
sons past the middle age. It simulates consumption very often, and 
at times only the skill of the physician can distinguish between the 
two. In these cases it requires the same treatment as consumption. 



WHOOPING-COUGH. 

This is a convulsive cough, accompanied with a shrill whoop, 
and returning in fits that are frequently terminated by vomiting. 

The disease comes on with a slight difficulty of breathing, thirst, 
quick pulse, hoarseness, cough, and all the symptoms of a common 
cold. In the second or third week after the attack, it puts on its 
particular and characteristic symptoms: the expiratory motions, 
peculiar to coughing, are made with more rapidity and violence 
than usual ; and, after several of these expirations thus convulsively 
made, a sudden and full inspiration succeeds, in which, by the air 
rushing through the top of the windpipe with unusual velocity, a 
peculiar sound is caused, which has obtained the name of whoop. 
When this sonorous inspiration has happened, the convulsive cough- 
ing is again renewed, and continues in the same manner as before, 
till a quantity of mucus is thrown up from the lungs, or the contents 
of the stomach are evacuated by vomiting, which generally termi- 
nates the fit ; the patient is then most frequently enabled to return to 
the amusements he was employed in before its accession, and often 
expresses a desire for food ; but, when the attack has been severe, it 
is succeeded by much fatigue, hurried breathing, and general lan- 
guor and debility. After a longer or shorter continuance of the 
disease, the paroxysms become less severe, and at length entirely 
cease. In some instances it has, however, been protracted for sev- 
eral months, and even for a year. Its chief danger is in the fact 
that it induces formidable diseases of the lungs and of the brain. 

Treatment. — Endeavor to secure the right action of the bowels, 
skin, and kidneys, by the use of small doses, one to three grains, of 
mercury and chalk, or by one to three grains of powder of ipecac, 
and by giving the child in its drink a few grains, every day, of 
the bicarbonate of potash. This part of the treatment will be more 



128 DISEASES OF CHEST AND RESPIRATORY ORGANS. 

effective if the disease is in the first, or inflammatory stage, includ- 
ing generally the first week or two. 

Give then, as a specific against the cough, the following mixture : 

Carbonate of potassa, 20 grains. 

Cochineal, . . . 10 grains. 

Sugar, 1 ounce. 

Water, 4 ounces. 

Give a child a teaspoonful every two or three hours. This is 
an eificient remedy, and, if it does not cure, it is because the irrita- 
tion in the pneumogastric nerve, of which whooping-cough is the 
consequence, is kept up by disorder of the stomach. 

Use then the following : 

Take of tartarized antimony, one drachm. Dissolve it in two ounces of 
water, and add tincture of Spanish flies, one ounce. — Mix for a lo- 
tion, a little of which is to be rubbed over the pit of the stomach, 
three or four times a day, till relief is obtained. 

This was once a famous nostrum, called Struve's lotion for the 
whooping-cough, and is very effective in the proper cases. 

The following mixture is also effective in uncomplicated cases : 

Tincture of belladonna, 1 drachm. 

Paregoric, 1-J drachms. 

Compound tincture of bark, 5 drachms. 

Syrup of tolu, 2 ounces. 

A teaspoonful to be given three times a day to a child from six to ten years old. 



ASTHMA. 

Difficulty of breathing, occurring in paroxysms, most frequently 
in the evening or about midnight, attended with a wheezing noise, 
great anxiety, and spasmodic impediment to the free admission of air 
into the lungs, are the symptoms of this disease. The countenance, 
at first pale, becomes flushed ; the eyes prominent ; the pulse weak, 
irregular, and frequent. There is often a feeling of impending suf- 
focation. The attack may pass off entirely after some hours, or the 
difficulty of breathing may continue in a less degree for several 
days, attended with a distressing dry cough. The paroxysm is 
prone to return, at, uncertain intervals. Each paroxysm generally 
subsides with cough and expectoration of tough mucus, the cough 
becoming looser as the paroxysm subsides. 

Distinctive Symptoms. — Spasmodic affections of the larynx, 
acute bronchitis, angina pectoris, and dropsy of the chest, may give 



ASTHMA. 129 

rise to symptoms ^which might be mistaken for those of asthma, 
more especially in those attacks which have a spasmodic character. 

Spasmodic affections of the larynx are attended with a peculiarly 
harsh noise, very different from the wheezing of asthma. The 
dread of suffocation is also more urgent than in asthma. 

In acute bronchitis there is inflammatory fever, with fuller pulse ; 
expectoration from the commencement of the attack ; and the diffi- 
culty of breathing is less urgent and more constant. 

In angina pectoris the character of the pain, and its seat in the 
region of the heart, with the general circumstances of the attack, 
distinguish it from asthma. 

Dropsy of the chest may generally be distinguished by its being 
the consequence of long-standing disease, and by its being accom- 
panied by dropsy of other parts. 

Treatment. — The first object is to shorten or relieve the fit ; the 
next, to prevent its return by appropriate treatment in the interval. 

The exciting causes are, violent mental emotions, sudden exposure 
to cold, over-exertion of the organs of voice, the inhalation of irri- 
tating or dusty particles, as in various arts ; and these causes should 
be kept in view in the treatment, since, by finding the origin of the 
particular fit, there is often some circumstance pointed out for facili- 
tating relief. 

1. During the Paroxysm. — Apply warm and stimulating sub- 
stances to the surface of the chest ; either mustard-plasters or flan- 
nels wrung out of boiling water, and then sprinkled over with spirits 
of turpentine, and applied hot to the surface of the chest, being re- 
newed as they get cool, until the skin is thoroughly reddened; At 
the same time the feet should be placed in hot water with mustard. 

An emetic of ipecacuanha should be given ; from twenty to 
thirty grains of the powder in warm water, vomiting being pro- 
moted by draughts of warm water. When its action has subsided, 
the following mixture should be taken at regular intervals of three 
or four hours : 

Paregoric, ... 4 drachms. 

Sulphuric ether, 2 drachms. 

Spirits of camphor, \ drachm. 

Tincture of asafoetida, 2 drachms. 

Water, 6 ounces. 

Two tablespoonfuls for a dose. ** 

In many persons, strong coffee will abate the symptoms more 
readily than any other article. In others, stramonium— the common 
stink-weed— is very effective. The patient should smoke cigars 
made with it, inhaling the vapor. 



130 DISEASES OF CHEST AND RESPIRATORY ORGANS. 

The age, strength, etc., of the patient must be particularly borne 
in mind in the selection of remedies for asthma. In the aged or 
feeble, ammonia, ether, etc., should be administered. Although in 
the younger and fuller-habited patients stimulants and antispas- 
modics may be given, they should be used more sparingly. 

Much benefit is often derived, during the paroxysm, from inhaling 
the vapors of camphor, ether, and balsam of tolu, with the steam of 
water. 

In the attempt to prevent future paroxysms by curing the state 
of the organs on which the disease depends, the history of the case 
and the character of the paroxysms must be considered. 

There are three distinct and principal causes or sources of this 
disease, viz. : 1. Dry cough ; 2. Organic disease of the heart, or 
large blood-vessels / 3. Disorder of the nervous influence simply. 

1. By dry cough is meant an habitual thickening or congestion in 
some part or other of the mucous membrane of the lungs. It is par- 
ticularly remarkable in the smaller branches of the bronchia, or air- 
passages, and it is reasonable to suppose that, if this swelling and 
thickening takes place beyond a certain degree and extent, it will 
obstruct the passage of the air, more or less completely, and thus 
give rise to asthma. 

2. Organic disease of the heart, or large blood-vessels, gives rise 
to asthma, by causing an extension of disease to the lungs, and by 
occasioning an irregularity in the transmission of blood through 
them. 

3. In some instances of asthma there exists no sign whatever of 
vascular congestion or thickening, or of any other organic lesion; 
and then we can attribute it only to disorder of the nervous influence 
simply. The case is purely one of spasm affecting the air-tubes. 

It is commonly divided into two species, the dry, spasmodic, or 
nervous asthma ; and the humid or habitual asthma. In the former, 
the fit is sudden, violent, and of short duration ; the constriction on 
the chest is very hard and spasmodic; the cough slight, and the 
expectoration scanty, and only appearing toward the close of the fit. 
In the second species, or habitual asthma, the paroxysm is gradual 
and protracted ; the constriction of the chest is heavy and laborious ; 
the cough severe, and more or less constant ; the expectoration com- 
mencing early, soon becoming copious, and affording great relief. 
The spasmodic asthma is the less frequent of the two forms. 

In the spasmodic cases the treatment must be directed to im- 
proving the health of the nervous system, by tonics, cold bathing, 
and proper regulation of all the functions. 

Nothing is more likely to confirm this form of asthma than con- 



SORE-THROAT. 131 

finement to the sick-room ; on the contrary, the tepid salt-water 
shower-bath, cooled down by degrees, until it can be taken quite 
cold, should be used every morning, in all seasons, immediately on 
getting out of bed, and be followed by brisk friction, with hair 
gloves, over the whule of the body. Exercise in the open air should 
be taken, in every kind of weather, and the best means, both medi- 
cinal and dietetieal, adopted, to augment the tone and vigor of the 
system. The diet should be moderate in quantity, and of a dry 
kind ; the bed of the invalid ought to be a firm mattress, the cover- 
ings light, and there should be no bed-curtains. Self-indulgence in 
all forms must be combated by the asthmatic, before any hope of 
cure, or even temporary relief, can be expected. 

In the form depending on heart-disease, we can only do service 
by keeping the heart quiet with sedatives, such as the wild-cherry 
bark. 

In asthma dependent on disease of the lungs and bronchial tubes, 
this disease is a thickening of the mucous membrane, and must be 
treated by patient persistence in an alterative course. Sulphur- 
baths, and the use of the water of a sulphur-spring, are often bene- 
ficial. 

SORE-THROAT. 

In quinsy, in addition to the pain and difficulty in swallowing, 
on looking into the throat the tonsils or glands on each side will be 
seen considerably swollen; on the outside of the throat, at the 
angles of the jaws, a fulness may also be felt, with tenderness on 
pressure. The voice is altered and thickened. As the disease ad- 
vances the voice becomes more stifled, swallowing is almost impos- 
sible, breathing is impeded, and at last suffocation seems to be 
threatened. At length, after these symptoms have existed for 
several hours, or in some cases for a day or two, relief is obtained 
by the bursting of the tonsils, in one or both of which the inflam- 
mation has gone on to form an abscess. 

In simple sore-throat the tonsils may be somewhat swollen, but 
not to the extent of quinsy : their surfaces will present patches of 
yellow lymph on a sore-looking surface with ragged edges. The 
difficulty of swallowing is not so great, nor is the breathing im- 
peded. 

Treatment. — The object is first to break up the attack by ac- 
tive treatment, and so prevent the formation of an abscess in the 
throat, and the consequent constitutional disturbance. Should the 
disease prove obstinate and this plan ineffectual, the next effort 



132 DISEASES OF CHEST AND RESPIRATORY ORGANS. 

must be to hasten suppuration and the discharge of the matter. 
Begin, therefore, in a person of full strength, with an emetic : 

Powder of ipecac, 30 grains. 

Tartrate of antimony and potassa, . . • . . . ■£ grain. 

Water, .... 2 ounces. 

Mix, and take at one dose. 

Apply also in case of an adult from ten to twenty leeches, and, 
if these give no relief, apply a blister at the angle of the jaw on each 
side. Give ten grains of blue-pill, and after it a dose of sulphate of 
magnesia. 

Should the inflammation still hold on after this treatment has 
had its £dl effect, keep the patient on a diet of gruel, apply warm 
poultices at the sides of the neck constantly, and let him breathe 
the vapor from hot water. This will hasten the formation of the 
abscess, and, when that is broken, tonics only will be necessary. 
During the formation of the abscess, however, watch the case very 
closely, for some embarrassment to the breathing may occur. 
Should this seem imminent, open the abscess. 

For simple sore-throat, it will be only necessary to give the blue- 
pill and purgative, and use a gargle of alum-water. 



CONSUMPTION. • 

This is a wasting of the system from disease of the lungs due to 
tubercles. The formation of tubercles in the lungs may arise from 
various causes ; where there is predisposition, the most trifling ex- 
posure to cold or damp, the least deviation from the rules of health, 
will frequently develop the disease ; and, even where there is not, it 
requires but little to set it up. Among the most general of the pre- 
disposing or exciting causes, may be mentioned, in addition to the 
hereditary taint already spoken of, a scrofulous habit of body, a 
peculiar formation of the chest, compressing the space appropriated 
to the lungs, so that they cannot have free play; this is sometimes 
the result of artificial compression. Inflammation of the lungs, 
catarrh, syphilis, small-pox, measles, or any disease which has a ten- 
dency to impair the quality of the blood, or weaken the system, may 
be classed among the causes of consumption ; as may certain em- 
ployments which necessitate the breathing of an atmosphere loaded 
with impurities, causing irritation of the pulmonary passages, which 
is likely to extend to the lungs themselves, and initiate tubercular 
disease. Hair-dressers, bakers, millers, masons, bricklayers, labora- 
tory-men, coal-heavers, chimney-sweeps, dressers of flax and hemp, 



CONSUMPTION. 133 

and workmen in leather-warehouses, are all especially liable to pul- 
monic disease. A slight cough resulting from a cold caught by sit- ' 
ting in a draught, or getting wet, or wearing damp linen, will if 
neglected often become worse, and eventually lead to consumption. 
So too will scrofula, with which a large proportion of the ill-fed, ill- 
clad, and worse-housed working-people are affected. 

The symptoms of consumption, although they vary somewhat 
with the cause of the disease, yet have a general similarity in their 
character. There are at first languor and a sense of debility. On 
the slightest exertion the pulse becomes accelerated, and the breath- 
ing difficult ; there is often a short, dry cough, which increases in 
strength and frequency. At first there is little or no expectoration, 
but gradually this comes on, and eventually becomes copious, the 
thick mucus being after a while streaked or tinged with blood. 
There are gradual emaciation of the body and loss of strength ; then 
come night-sweats, disturbed rest, and a hectic flush, or spot on the 
cheek — constant thirst, and a cough which seems to gather strength, 
in proportion as the frame, which it racks and tears, becomes more 
and more attenuated. There is at first a sense of tightness on the 
chest ; then, as the respiration becomes more labored, succeed sharp, 
cutting pains, particularly under the sternum, or breast-bone, and at 
the time of coughing; very commonly the mind partakes of the 
weakness of the body, and sinks into a desponding state, or has sud- 
den alternations of hope and fear. The termination of the sad scene 
is sometimes brought about by the rupture of one or more of the 
blood-vessels of the lung s in a fit of coughing ; haemorrhage ensues, 
and the patient sinks exhausted. 

Treatment. — Avoid, so far as possible, all the above-mentioned 
depressing agencies. Seek a genial climate, such as will permit of 
following healthy out-door occupation ; take regular and moderate 
exercise ; protect against exposure to extreme changes of tempera- 
ture, as from heated rooms to cold, damp air, with insufficient cloth- 
ing, thin shoes, etc. Shun .all things which will prevent the free 
expansion of the lungs. 

By observing these means, and by adopting a liberal, even a full 
diet, and using all means to improve and maintain the general 
health, it not very unfrequently happens that the disease becomes 
dormant, and a silent process of healing goes on ; but it is not with- 
in the power of man, as yet, to point out the particular cases in 
which this shall take place ; therefore the pretension to cure con- 
sumption is sheer quackery. 

Although consumption is not proved to be contagious, it is de- 
sirable that, where a suspicion of constitutional tendency to the dis- 
ease exists, the person should avoid breathing the impure air expired 



134: DISEASES OF CHEST AND RESPIRATORY ORGANS. 

by a consumptive patient, as it is unwholesome under any circum- 
stances. 

The proper treatment is that which is calculated to improve the 
nutrition, prevent the irregularities of the circulation, which tend to 
promote the tuberculous deposits, and, as far as possible, to elevate 
the condition of the health. 

Pure air, nutritive digestible food, regular exercise, and well- 
arranged habits of life — these and their correlative hygienic meas- 
ures stand in the first place, because they are equal or superior in 
power to any form of medicine, properly so called, in preventing the 
development of the disease. 

There is one remedy infinitely superior to any other, and which 
stands quite in the front rank of remedies. It is cod-liver oil : it 
stands entirely alone as an agent in counteracting the condition 
which is peculiar to this disease. It is a mistaken view to regard 
cod-liver oil as a material which only plays the part in the body of 
a simple nutrient. It has other and directly therapeutic powers. 
There is not only an improvement of the system generally under its 
use, but a diminution in the amount of tubercular deposit. It pro- 
motes the dispersion, absorption, and removal of tubercle. 

At the commencement, the best plan is to take a teaspoonful or 
two of the oil, twice or thrice a day, floating on a little tincture of 
ginger or orange-peel. In the course of eight or ten days, the dose 
may be increased to three teaspoonfuls, or a tablespoonful at a 
dose ; and it may be taken at any time of the day the patient likes 
best, but the greatest distance from meals is to be preferred. 

It has been claimed that many cases of this disease are curable 
by vomiting alone. Common salt has also been counted as a reme- 
dy, taken in quantities of half a drachm a day — the patient eating 
only broiled beef and mutton. This is a remedy so simple, and so 
accessible to all, that it need not want proof for want of trial. 

Distressing symptoms must be combated as they arise. Cough 
is perhaps the worst of all these. Sometimes this is effectually re- 
lieved by inhalation of creosote. Put ten drops of creosote in a tea- 
pot — pour on it a pint of water, and breathe the vapor through the 
spout. Or use this mixture : 

Syrup of wild-cherry bark, .3 ounces. 

Syrup of tolu. 1 ounce. 

Diluted hydrocyanic acid, 16 drops. 

Half a tablespoonful is the dose, and should be taken, according 
to the urgency of the cough, once in two or three hours. 

Sedatives are the true remedy in this cough, as of course we can- 
not remove the cause. 



CONSUMPTION. 135 

For the night-sweats give every night, for several nights togeth- 
er, four grains of the oxide of zinc, and two grains of the extract of 
hyoscyamus, made into pills ; or give this pill, used in the consump- 
tion hospital at Brompton, London : 

Gallic acid, 5 grains 

Hydrochlorate of morphia, -J- grain. 

To be made into two pills with gum. Take no fluid whatever for several 
hours before bedtime. 

For the diarrhoea use astringent powders, as follows : 

Subnitrate of bismuth, 1 drachm. 

Powder of gum-arabic, •£ drachm. 

Magnesia, . . . . " 1 scruple. 

Divide into 12 powders, of which take 1 every 4 hours. 

Should the patient raise blood, ipecacuanha-wine, or powder, and 
Epsom salts, combined in such small doses as operate mildly on 
the bowels, and produce slight nausea, will prove of service. Give 
the following draught immediately, and, should the nausea excited 
by it be insufficient, or the bowels be too much acted upon, the dose 
of ipecacuanha may be increased, or that of the salts lessened, ac- 
cordingly, since the proper manner of using this form is, to combine 
the medicines in such proportions as will act mildly, yet sufficiently, 
in the way described : 

Take of ipecacuanha-wine, 1 or 2 drachms, 

(Or ipecacuanha-powder, 1 or 2 grains). 
Epsom salts, ...... 1 drachm. 

Infusion of cascarilla-bark, . . .10 drachms. 

Mix for a draught ; to be taken in the beginning, every second hour, and, 
after it has checked the bleeding, twice or thrice a day, so as to keep 
up a gentle action on the bowels. » 

In cases of emergency, where no other remedy is at hand, give a 
teaspoonful of common salt, and repeat it frequently. 

Nitre has been strongly recommended, and is often of great 
value, more especially in full habits. The Italian physicians have 
unlimited confidence in it, and employ it in large doses, as half a 
drachm dissolved in cold water, repeated three or four times a day. 
It should not be continued longer than two or three days at a time. 

If the foregoing means fail of success, which they rarely will, the 
superacetate of lead should be tried. It is a most powerful astrin- 
gent, and may be given in this form : 

Take of acetate of lead, . ' . . . 3 grains. 

Distilled vinegar, £ drachm. 

Laudanum, 10 drops. 

Water, 1£ ounces. 

Mix for a draught, to be taken every two or three hours, until relief is 
obtained. 



DISEASES OF DIGESTIVE OKGANS. 



INFLAMMATION OF THE MOUTH {Stomatitis). 

Inflammatoky disease of the mouth appears in several forms. 
There may be simple inflammation resulting from contact of hot 
liquids or corrosive substances ; or small white inflammatory ulcers, 
indicative of derangement of the system ; or gangrenous and mer- 
curial sore-mouth, and the sore-mouth of scurvy. 

For the simple inflammation, use ice and iced demulcents— as 
gum-water and flaxseed tea. The sore-mouth of scurvy will yield 
to the treatment of that disease. For other forms of sore-mouth, 
chlorate of potassa may be almost looked upon as a specific. Give 
it freely in adults, and an infant may take from one to five grains, 
dissolved in water. 

CANKER SORE-MOUTH (Cancrum Oris). 

This is a gangrenous inflammation which chiefly affects the 
cheeks and gums of children of a weakly, scrofulous habit, with 
constitutions debilitated by impure air, want of wholesome food, 
and all the influences of poverty and wretchedness which surround 
so many of the poorer classes. Sometimes, however, it originates in 
other classes from the use of mercury. Very frequently the disease 
shows itself soon after measles, scarlet fever, or other acute inflam- 
matory affections. Its first symptom is usually a hard red spot on 
the cheek, which spreads and opens into a shallow ulcer on the in- 
side, discharging matter of a peculiarly offensive character. As the 
disease progresses, the cheek swells, the breath becomes fetid, there 
is a great flow of saliva, which is often tinged with blood; there is 
mortification of the surrounding parts, including the gums, the teeth 
drop out, typhoid symptoms show themselves, and, finally, the 



INFLAMMATION OF THE STOMACH. 137 

patient sinks exhausted, death coming like a happy release from its 
sufferings. This is the usual course, if early efforts are not made to 
arrest the progress of the disease. As soon as the red spot in the 
cheek gives warning of its commencement, the constitution should 
be strengthened with good, nourishing diet, such as beef-tea, milk, 
and eggs, if the stomach will bear them ; wine, if there is extreme 
debility and no great amount of fever. Quinine, in half-grain doses, 
three times a day, in infusion of gentian, or decoction of bark, may 
be given, or some preparation of iron with a warm stomachic. The 
following mixture is perhaps as good as any : 

Wine of iron, 2 drachms. 

Compound tincture of cardamoms, or of valerian, . . 2 drachms. 
Made up to 8 ounces with cinnamon or mint water ; one or two table- 
spoonfuls twice or thrice a day. 

Change of air, sea-bathing, and any thing which is likely to in- 
vigorate the constitution, should also be tried. Chlorate of potash, 
one drachm, with twenty drops of muriatic acid, in six ounces of 
water sweetened with a little syrup of orange-peel, is a pleasant and 
serviceable mixture ; it may be given to a child six years of age, a 
tablespoonful about every four hours. For local treatment, lunar 
caustic, or sulphate of copper, rubbed along the edges of the wound, 
is recommended. The mouth should be frequently washed with 
a lotion made of chloride of soda and water, in the proportion of 
two drachms of the former to half a pint of the latter ; or it may 
be one drachm of chloric ether to the same quantity. By this means 
the unpleasant fetor is diminished so as to be endurable. Canker 
may be produced by the contact of copper or brass with the inside 
of the mouth. It is very often attributable to mercury. 

INFLAMMATION OF THE STOMACH {Gastritis). 

Burning pain at the pit of the stomach, increased on swallowing ; 
rejection of everything swallowed; hiccough, with oppression and 
dejection of mind, and high fever, are the symptoms denoting this 
disease. The pain is extremely acute, but is not always confined 
exactly to the region of the stomach, for it sometimes extends so 
low as the false ribs, and often shoots to the back. It is always 
much increased by even the slightest external pressure, and the 
vomiting is a more constant symptom than the hiccough. The pulse 
is frequent, small, contracted, hard, and sometimes intermitting. 
The thirst is urgent, and the bowels costive. The depression of 
strength is more sudden and general than in any other inflammation. 
The patient complains of anxiety and anguish referred to the pit of 
the stomach, and actual fainting sometimes occurs. 



138 DISEASES OF DIGESTIVE ORGANS. 

The causes are generally abuses of the organ — as indulgence 
in use of stimulants, gluttony, etc. There is, perhaps, no cause of 
this disease so common as suddenly checking the perspiration by 
drinking cold fluids. 

Spasm of the stomach is distinguished from inflammation by 
its being unattended with the sudden sinking of strength above 
noticed, by the pulse being natural, and by there being little or no 
increase of pain on receiving any thing into the stomach, or on 
pressure. 

If the prostration is not too great, apply leeches to the region of 
the stomach, or apply mustard-poultices. Keep the patient abso- 
lutely quiet (in bed), and avoid all irritation of the organ. Give no 
medicine but a teaspoonful of lime-water mixed with a teaspoonful 
of milk, once in three hours ; or give mindererus spirit at the same 
interval. Should the bowels not be moved for several days, use an 
injection. It may also be necessary to support the patient by 
injections of beef-tea and wine. 



INDIGESTION, OR DYSPEPSIA. 

Indigestion is a disorder of the stomach and small intestines, the 
most striking symptoms of which are, difficult digestion of the food, 
sense of oppression or uneasiness after eating, capricious and deficient 
appetite, and costiveness. It is essentially a debility of the stomach 
and smaller bowels, though the weakness and disorder of function 
frequently extend to the liver, pancreas, and other organs asso- 
ciated in the perfect digestion of the food. The difficulty occurs 
occasionally, and may result from any disturbance of the system. 

When the same state is chronic or continual, it is called dyspep- 
sia. There is then always a sense of distention or oppression after 
eating ; acrid eructations ; constipation and uneasiness of the bowels, 
sometimes looseness, furred tongue, impaired appetite and strength, 
flatulency, discolored stools, they being either green, black, or much 
too light; nausea, headache, sometimes bilious vomiting, palpita- 
tion of the heart, pain in the pit of the stomach, and toward the 
right side; sallowness of complexion, and depression of spirits. 
The whole of these symptoms, however, are not always present ; 
but, under whatever form, and from whatever cause the disease 
occurs, there is a considerable degree of general languor and debility, 
exercise or exertion of any kind soon fatigues ; the pulse is weak, 
the sleep disturbed, the limbs are cold, or rendered so on slight 
occasions ; and a sense of distention and oppression, acrid eruc- 



INDIGESTION, OR DYSPEPSIA. 139 

tations, nausea, headache, constipation, pain in the pit of the 
stomach, and sallowness of complexion, are pretty constantly pres- 
ent. 

Frequently there is a good deal of general feverish heat, flushing 
of the face, dryness in the mouth, weakness of the knees, and a dry, 
scurfy state of the general surface of the body. Different organs 
are at fault in different manifestations of this disease. Dyspepsia 
may result from disorder of the liver, disorder of the stomach, or 
disorder of the bowels ; aside from some remoter causes of occa- 
sional occurrence, these are generally the starting-points. The first 
and most important step to be taken in the cure is, to remove such 
habits and pursuits as may have given rise to the disease, and con- 
tinue to aggravate it : until this has been effected, remedies will be 
found of little avail. If the patient leads a fashionable life, it will 
be necessary for him to forsake the haunts and habits of dissipation; 
to leave the crowded city ; to shun luxurious tables, indolence, and 
late hours ; and to retrace the footsteps by which he has deviated 
from simple nature, and to court the country, pure air, active 
exercise, early rising, simple diet, the society of a few select 
friends, and pleasing occupations. The man of severe study must 
in a great measure lay aside his books ; the fagging tradesman or 
merchant will find it indispensably necessary to enjoy relaxation ; 
the hard drinker must greatly diminish his potations, especially of 
ardent spirits ; and all dyspeptics must take exercise in the open 
air freely, rise early, seek cheerful society, and carefully observe a 
moderate and correct diet. 

1. The drinker must relinquish his potations, because they de- 
range the action of his liver. 

2. The eater of great dinners must go to plain fare, because his 
luxurious diet tempts the palate, so that his stomach is broken 
down, like an omnibus-horse, by too much labor. 

3. The lawyer or shopkeeper must remit confining occupation, 
because it breaks down the energy of the nervous system, and en- 
feebles the action of the stomach and the bowels. 

As to medicine, let it be kept in mind that, whatever plan is 
adopted, much depends on the gentleness of the effect produced, the 
morbid condition being only removable by a slight effect, regularly 
kept up for a considerable length of time. All powerful means, 
which are necessarily transitory, because they would soon destroy 
the patient if they were continued, not only fail to cure, but very 
often aggravate the disease. It is, therefore, of the greatest im- 
portance that the patient should remember it is by the most gentle 
and frequently-repeated impressions that the organs are solicited to 



140 DISEASES OF DIGESTIVE ORGANS. 

resume their healthy action in all protracted cases, more especially 
if considerable hardness of the pulse be present. 

In the vast majority of cases, more especially with women, the 
bowels require the first attention. In a great many instances, where 
there is more or less constipation, the difficulty is overcome by 
simply directing our thoughts to the condition. In others, warming 
the feet will cause a natural evacuation of the bowels — in others, 
again, rubbing the belly will effect it, and many know some article 
of diet that proves laxative to them. It is better to adopt any of 
these means than to take medicine. Should the case, however, re- 
sist all such means, medicine must be used. Either of the following 
preparations will be effective : 

Tincture of rhubarb, . . . . . . . 1 ounce. 

Tincture of aloes, 1 ounce. 

Tincture of ginger, 2 drachms. 

Mix, and take a teaspoonful every day. 

Resin of podophyllum, 2 grains. 

Powder of rhubarb, . ....... 8 grains. 

Mix, and make 8 pills, of which take one a day. 

At the same time take, once a week, five grains of the powder of 
mercury and chalk. Should the stools continue dark and offensive, 
this may be taken oftener — once in three days. Where there is 
water-brash, with a sour taste in the mouth, take daily a teaspoonful 
of lime-water — or use the following : 

Sulphite of soda, . 1 drachm. 

Make 12 powders, of which one is a dose. 

If the pain comes on immediately after eating and is persistent, 
take one of the powders below every day : 

Subnitrate of bismuth, ■ 2 drachms. 

Sugar, . 1 drachm. 

Powder of ipecac, 12 grains. 

Mix, and make 12 powders. 

Bitters may be taken at the same time. The best are cham- 
omile, gentian, columba, and chiretta. In making an infusion or a 
tincture of any of these, add so much of the tincture of nux- vomica 
as will give three drops to every dose. 

Should there be, with the inability to digest, a good appetite for 
plain food, give iron : either the carbonate of iron in Valet's mass, 
from three to twelve grains a day; or the tartrate of iron and 
potassa about six grains a day, or the tincture of the chloride of 
iron, in doses of from ten to thirty drops, three times a day. If 
there are weak lungs and any tendency to tubercles, take no iron ; 



GASTRALGIA—CARDIALGIA—C CELIAC NEURALGIA. 141 

and, if iron gives headache, trust the case entirely to the vegetable 
tonics. 

As an auxiliary remedy, the cold bath merits much attention, 
or, if preferred, cold sponging may be substituted for the cold bath. 
The whole surface of the body should be sponged regularly every 
morning with cold water, the patient rubbing himself dry after it 
with a coarse towel. The power of daily active exercise in the open 
air in curing dyspepsia is very great, indeed such as would appear to 
the majority of persons almost incredible ; and, therefore, it cannot 
be too much insisted upon by the physician, as an indispensable 
requisite to insure perfect freedom from this complaint. Many lay 
great stress upon attention to diet, as necessary in the treatment of 
this and other chronic disease, and so it is ; but experience proves 
that exercise and cold water are the most essential branches of the 
regimen. Exercise is not so strenuously recommended as it ought 
to be, or its virtues so fully known as they deserve. Yet it is 
not good in all cases. The very feeble must take it carefully, and 
in many, absolute rest is of the first importance. Overworked 
women, particularly, will often find some weeks or months of recre- 
ation worth all other remedies. Cheerful company and lively con- 
versation, with proper clothing, are also subjects of importance. 
The feet and chest should be kept warm. 



GASTRALGIA— CARDIALGIA— CCELIAC NEURALGIA. 

Symptoms. — Paroxysms of pain, more or less severe, and of varia- 
ble duration, generally confined strictly to the region of the stomach, 
and ordinarily without any of the more usual symptoms of gastric 
derangement, and without fever. Sometimes the pain is rather an op- 
pressive or tensive uneasiness, but oftener it has the character and 
severity of the worst neuralgia, and in its effects on the sufferer seems 
to threaten immediate dissolution. It is not altogether without dan- 
ger, but is not often fatal. Fatal cases only occur when this disease 
coincides with some other severe disease of the stomach that is 
chronic. Gastralgia is commonly a complication of some other dis- 
ease, but occurs alone mainly in systems enfeebled by sedentary 
occupations, attention to business or study, or by excesses. It is 
peculiar to women, and to men of the less robust type. 

Treatment. — This must depend upon the cause of the disease, 
and must endeavor, first, to allay the immediate paroxysm, next to 
strengthen the system against recurrence. Free application of 
chloroform to the surface immediately over the seat of pain will 
perhaps be required when the pain is exceedingly severe. Chloro- 



142 DISEASES OF DIGESTIVE ORGANS. 

form and tincture of aconite in equal parts may be applied in the 
same way, sometimes with more effect. At the same time, in the 
severe paroxysms, a tablespoonful of warm brandy, with twenty 
drops of laudanum in it for an adult, may be given. Should the 
pain be less severe, either the brandy or the laudanum alone will 
generally suffice. 

Exposure to cold or wet will induce this disease ; so will the 
marsh miasm ; and, with rheumatism or gout, it is pretty sure to 
occur sooner or later. Diseases of the uterus cause it — in thick- 
ening, ulceration, or chronic inflammation of the stomach, it will re- 
sult from the contact of alimentary substances, and even medicines. 
In very irritable stomachs in dyspeptic persons, the ingestion of a 
glass of cold water, of wine, or a dish of ice-cream, will bring on 
frightful paroxysms. In instances like any of these, the permanent 
cure will require strict attention to the primary disease. Guard 
against exposure, against imprudence in eating and drinking, neu- 
tralize the miasm, attend to the several disorders of the system, and 
you will do the best that can be done against the gastralgia. If the 
disease is not thus obviously dependent upon some other, it must be 
treated with tonics. Bismuth has been used very freely, and almost 
as a specific, in the following mixtures : 

Subnitrate of bismuth, 20 grains. 

Sugar, 20 grains. 

This dose may be taken with syrup. Another more composite 
formula meets other than the merely nervous indications. 

Subnitrate of bismuth, 60 grains. 

Extract of opium, 10 grains. 

Powder of ipecac, . 10 grains. 

Magnesia, 5 grains. 

Sugar, . . . . . . ... . . 5 grains. 

90 grains. 
Make 20 powders, of which take one every hour. 

This may be followed by the use of the carbonate-of-iron pills, 
or the tincture of chloride of iron in ten-drop doses, three or four 
times a day, especial attention being given to having the bowels 
freely moved every day. 

GASTRIC ULCER. 

Ulcer of the stomach occurs more frequently in women than in 
men, and in the poor than in the rich. It may prove fatal, by per- 
forating the stomach and causing peritonitis, or by opening a vessel, 
and so leading to sudden haemorrhage. 

The symptoms are those of derangement -of the stomach gen- 



CANCER OF THE STOMACH— VOMITING BLOOD. 143 

erally, but the prostration is peculiarly marked. The pain over 
the stomach is different from the pain of simple dyspepsia. In dys- 
pepsia, the pain is caused by the food taken. In ulcer, the pain 
is constant, and is made worse by food. If the ulcer perforate, the 
sudden prostration amounts to collapse, from which the patient does 
not rally. 

Treatment. — Opium, astringents, and demulcents, are the effec- 
tive remedies. Give Dover's powder, ten grains, every five hours, 
and either kino or bismuth in powder, and the tincture of catechu 
in gum-arabic mixture. Irritating applications over the stomach 
are sometimes useful. 

Be very careful in regard to food, taking only small quantities 
at a time of bland substances, as arrow-root in milk. In severe 
cases, give no food by the stomach, but support entirely by injec- 
tions of beef-tea. 

CANCER OF THE STOMACH. 

The exciting causes of this disease are blows, particular occu- 
pations in which the stomach suffers by constant pressure, intemper- 
ance, and great mental depression. It scarcely ever occurs in the 
young. Hereditary influence is less marked in this than in other 
forms of cancer. 

Pain, sometimes severe, and becoming worse with a correspond- 
ing tenderness on pressure, is felt at the right side of the epigastrium, 
at the margin of the false ribs. The pain is worse when food is 
taken. Food and mucus, and mixed blood and mucus — " coffee- 
grounds" — are vomited. There are dyspepsia, fetid breath, and 
emaciation, and this latter may make perceptible a tumor at the seat 
of pain. Discovery of this tumor will render it in the highest de- 
gree probable, but not absolutely certain, that the disease is cancer. 

The disease is inevitably fatal. Nothing can be done but to 
fight off the slow starvation by highly-nutritious food, and soothe 
the pain by anodynes. Give beef-tea, cream, etc., as ordinary food 
cannot be digested, and opium in the form of watery extract, or the 
solution of the sulphate of morphine. Generally a year of misery 
ends the case, and two years is perhaps the extreme possible limit 
of life. 

YOMTTING BLOOD. 

Blood raised in considerable quantities, not frothy, of a dark 
color, and especially if mingled with food, is from the stomach. 
Blood may be vomited where there is ulcer of the stomach, in 
scurvy, in cancer of the stomach, or from aneurism of a small ves- 



144 DISEASES OF DIGESTIVE ORGANS. 

sel. If chronic, that is, occurring from time to time, there is danger, 
as it indicates some persistent disease of the abdominal viscera. 

Treat by abstinence from food, perfect rest in the horizontal 
position, cold to the epigastrium, and cold drinks, with astringents 
— ice, gallic acid. 

Gallic acid, 8 grains. 

Dover's powder, 5 grains. 

Make a powder, to be taken once in eight hours. 

Or, take fifteen to twenty drops, at intervals of a few hours, of 
the tincture of chloride of iron. 

In the form that recurs, give tonics regularly : 

Sulphate of quinine, 12 grains. 

Sulphate of iron, 12 grains. 

Water, . . ■ 3 ounces. 

Sulphuric acid to make solution. Take a tablespoonful twice a day. 

Give cream, raw eggs, cod-liver oil. 

CONGESTION AND INFLAMMATION OF THE LIVER. 

Having so important a duty to perform in the animal economy, 
it is of the utmost consequence that the liver should be kept free 
from disturbing agencies, so that it may be in a proper condition for 
the discharge of its functions. The evil to which it is most liable is 
a disturbance of its circulation, causing either active or passive con- 
gestion, both of which are by no means uncommon conditions of the 
organ ; in the former case, there will be an increase in the flow of 
bile; in the latter case, probably a decrease, or an altered state of 
the secretion. Congestion is the first step toward inflammation, and, 
if not remedied in time, leads to that disease. 

Active congestion of the liver may be a consequence of an irri- 
tated state of its tissues, owing, probably, to the retention in the 
blood of the materials which ought to have been taken up by the 
kidneys, the skin, or some other excretory organ ; or it may be 
owing to the pressure of too much carbonaceous matter in the food ; 
or there may be some local cause, some organic disease of the liver 
itself. Any one of these will tend to an excessive secretion of bile, 
and cause what are called bilious disorders. 

Passive congestion of the liver is usually the result of some 
mechanical impediment to the due supply of blood to the organ, or 
to its return from thence ; the mischief may be an impeded action 
of the heart, or a defective operation of the functions of the lungs ; 
or it may be caused by continued pressure upon the seat of the liver, 
such as results from leaning at a desk, or remaining in a stooping 



CONGESTION AND INFLAMMATION OF THE LIVER. 145 

position ; persons of sedentary habits are likely to be affected in 
this way. It may be merely what is called "a sluggish liver." 
There is a diminution in the quantity of the bile, but no alteration 
of its quality ; in the more severe forms of passive congestion, how- 
ever, the bile, after its secretion has been suspended for a time, be- 
comes acrid and plentiful, causing, when it passes into the intestines, 
much constitutional disturbance. 

The symptoms of congestion are generally great uneasiness in 
the right side, and a dull, heavy pain near to the shoulder-blade of 
that side ; if active, as before observed, the bile will be plentiful, 
coloring the evacuations, and producing often a bitter taste in the 
mouth, and leading sometimes to jaundice (which see) ; if passive, 
there are also the same uneasiness and pain in the region of the liver, 
with a diminished flow of bile, or a changed condition of it, as be- 
fore described ; and after a while there is probably acute inflamma- 
tion set up, which generally seizes on the substance of the liver, and 
involves the whole or only a part of it ; most commonly the former 
is the case. 

In the acute stage of inflammation there is pain in the right 
side, which is increased on pressure, or when a deep breath is 
drawn; there is usually, too, quick breathing, often a cough, but 
not always either of these. Nearly always there is pain in the right 
shoulder, and more or less of yellowness of the eyes, and, indeed, 
of the whole skin; occasionally absolute jaundice; the urine is 
high colored, and the faeces either pale and clayey, or tinged with 
greenish yellow bile ; vomiting, too, is sometimes a symptom. 

Treatment of acute liver inflammation should be active measures 
of depletion to prevent the formation of abscesses. If the system 
will bear it, there should be cupping or leeching over the seat of the 
organ, to be followed up with hot bran-poultices, and afterward by 
a blister, the latter to be several times repeated if required. The 
bowels should be freely opened, and the system reduced by calomel 
combined with colocynth, or some other active purgative, to be fol- 
lowed by a saline aperient mixture, as follows : 

Epsom salts, 6 drachms. 

Liquor of acetate of ammonia, 1 ounce. 

Tartrate of potash, 2 grains. 

Wine of colchicum, 1 drachm. 

Camphor-mixture sufficient to make six ounces ; one ounce to be taken 
every four hours. 

The calomel to be kept up for some time in small doses, com- 
bined with opium if the pain is violent. When there is reason to 
believe that suppuration has taken place, the treatment must be 



146 DISEASES OF DIGESTIVE ORGANS. 

altered, and nourishing food and tonics given with mineral acids, 
such as the muriatic, with gentian. In chronic inflammation the 
pains may be relieved by bleeding, dry cupping, repeated blisters, 
and small doses of mercury ; gray powder with rhubarb, or blue 
pill, will be best. Epsom salts, or mineral waters, should be taken 
regularly, with moderate exercise. A light but nourishing diet, 
and, if possible, change of air and scene. 

CIRRHOSIS {Hobnailed Liver). 

This is an inflammation of the fibrous connective tissue of the 
liver, causing it to contract. As the resistance of the substance of 
the liver to this contraction makes it unequal, there are nodules left 
all over the surface, which may sometimes be felt on the outside in 
thin persons. 

The symptoms are obscure. There are pain in the right side — 
indigestion, constipation, occasional feverishness — dry and rough 
skin — debility, loss of flesh, jaundice, and dropsy, that begins in the 
belly. 

Treatment. — Abstain from all alcoholic liquors and stimulating 
drinks or dishes. Take plain animal food, and purge freely with 
sulphate of soda. Use quinine and iodide of iron in doses of one 
grain each. The disease is very intractable, and will probably not 
be suspected till it has made such progress as to be incurable. 

Treat the dropsy as directed in the article on that subject. 

BILIARY DERANGEMENTS. 

Bilious Disorders ; Bilious Attacks ; Sick Headache ; Bowel Complaint ; Bilious Diar- 
rhoea ; Functional Derangements of the Liver. 

Symptoms. — 1. Those of Diminished Secretion of Bile. — Irregu- 
lar or costive state of the bowels, the evacuations being insufficient- 
ly colored with bile ; flatulency, and various dyspeptic symptoms ; 
furred tongue ; nausea ; pain under right shoulder-blade ; headache, 
etc. ; dark specks floating before the eyes ; sallow or muddy com- 
plexion ; lowness of spirits ; piles. 

2. Of Excessive Secretion. — Copious fluid evacuations, highly col- 
ored with bile, often preceded by griping and by nausea, sometimes 
attended with vomiting ; pulse accelerated. 

Causes. — Residence in hot climates ; exposure to extremes or 
vicissitudes of weather ; the use of full, rich diet ; spirituous and 
fermented liquors in excess ; misuse of mercurial medicines ; neglect 
of the intestinal evacuations ; neglect of the cutaneous functions ; 



JAUNDICE. 147 

indolence and sedentary occupations ; mental emotions ; depressing 
passions ; disease of other organs, as long-continued dyspepsia, 
diarrhoea, or dysentery. 

Treatment. — In the first of the two forms above named, a mod- 
erate dose of a mercurial medicine, e. g., five grains of blue pill, fol- 
lowed by a warm aperient, will probably suffice to relieve the pres- 
ent symptoms. The treatment subsequently will consist in such 
diet, regimen, etc., as shall prevent the operation of the causes. 

Extract or decoction of taraxacum (dandelion) is a valuable 
remedy for disorders of the liver. 

Infants and young children are liable to indisposition from dimin- 
ished secretion of bile. The stomach becomes disordered, sickness 
occurs, the bowels are sluggish or irregular, and the evacuations 
pale or white. The child is fretful or weak. Sometimes profuse 
action of the bowels attends this condition of the liver. 

Two or three grains of gray powder (mercury with chalk), fol- 
lowed, after a few hours, by rhubarb or castor-oil, will generally 
suffice to remedy this disorder. 

It may, however, be requisite to repeat the gray powder every 
second or third night for a few turns. It is not then advisable to 
continue the purgative after each dose. 

The diet, at the same time, should be nutritious, but plain, e. g., 
beef-tea, with light farinaceous puddings, milk, etc. 

(For the treatment of the second sort of biliary disorder, see 
Diarrhoea.) 



JAUNDICE. 

This is rather a symptom of several diseases of the liver than 
properly a disease in itself. What it commonly indicates is suppres- 
sion of the flow of bile from the liver and gall-bladder into the intes- 
tines. This is the result of some inflammatory or nervous disturb- 
ance that closes up the bile-ducts, and the bile, not finding its natural 
outlet, accumulates, and, finally, as no more is secreted, the biliary 
coloring matter remains in the blood, and thus communicates its 
peculiar hue to the skin, the whites of the eyes, the urine, etc. 

The proper remedies are such as will remove the cause of obstruc- 
tion, and stimulate the flow : active purgatives, as resin of podo- 
phyllum, in two or three grain doses'; rhubarb, senna, or aloes ; and 
the sulphate of soda, taken freely. 



148 DISEASES OF DIGESTIVE ORGANS. 

GALL-STONES {Hepatic Colic). 

Concretions form in the liver — in the ducts of the liver, and in the 
gall-bladder — more frequently in the latter. When a stone of any 
size passes into the duct that leads from this latter to the intestine, 
there is the most excruciating pain, and great constitutional disturb- 
ances, rigors, sweating, intense agony. If the stone recede, or pass 
on, the symptoms cease ; but, if it remain impacted, as it is apt to, at 
the junction of the duct from the liver, it will wear the person out 
by the combination of the agony with the results of complete 
obstruction of biliary ducts. 

There is no treatment but to soothe the pain ; give opium in as 
full doses as the system will bear, from two to ten grains. If it 
affords no relief, give chloroform, but carefully. 

INFLAMMATION OF THE BOWELS AND PERITONAEUM. 

Symptoms. — Pain ; extreme tenderness on pressure of the abdo- 
men, and in the course of the intestines ; distention and sense of 
heat in the abdomen ; the knees drawn up, and bent on the body ; 
vomiting of bilious matter; skin, harsh and dry; pulse quick and 
hard ; urine scanty and high-colored ; thirst, loss of appetite ; tongue 
white and clammy, or dark brown and furred in its centre, but red 
at its point and edges ; general debility and prostration of strength. 
At first the bowels may be obstinately costive ; they afterward be- 
come relaxed, the evacuations being pale, yeasty, slimy, bloody, or 
offensive, dark and lumpy. There is frequent straining at stool, 
without free action of the bowels. 

Distinctive Characters. — It may be distinguished from colic by 
the presence of febrile symptoms, the more rapid pulse, and the pain 
of the abdomen being increased by pressure, whereas pressure 
relieves the pain of colic. 

Causes — Predisposing. — Sudden changes of weather ; damp and 
unhealthy situations; marshy districts in hot climates; debility; 
errors of diet as to quality and quantity ; suppression of perspiration 
by exposure to cold or damp ; intemperance ; inattention to the con- 
dition of the bowels ; the injudicious use of strong purgative medi- 
cines. Many poisons act fatally by producing inflammation of the 
bowels, as do also extensive burns and scalds. 

Treatment. — From eight to twenty leeches should be apj)lied 
over the painful part, according to the age of the patient and the 
severity of the attack. The bleeding may be encouraged by warm 
fomentations, or large warm bread-and-water or bran poultice. 



DIARRHOEA. 149 

Calomel and opium, to be given every two, four, or six hours. If 
the attack be not very severe, or if the patient be young or delicate, 
Dover's powder and gray powder will be preferable. Let it be 
borne in mind that the cure depends more on the opium than on the 
calomel. 

Give a grain of opium once in four hours, but give the calomel 
less freely — one or two grains a day. Let them be combined with 
tartar-emetic, one quarter grain for each grain of calomel. 

DIAKRH(EA. 

Hot weather, by the languor it induces, prevents the regular 
action of the liver. Stimulants of every sort, by causing a too 
great activity, cause also, by Nature's law of compensation, a sub- 
sequent sluggishness. Torpidity of the liver is a consequence of 
innumerable little accidents in the digestive system. Any of these 
interferences with the regular action of the liver, impeding the flow 
of blood through it from the intestines, the result is an accumulation 
of blood in the vessels that serve the whole intestinal surface ; and, 
as the obstruction continues and the vessels become more and more 
loaded, the pressure on their walls is finally relieved, of necessity, 
by a discharge of serum into the intestine. The blood yields its 
watery part, which, flowing into the intestine in greater or less 
quantity, causes diarrhoea. Diarrhoea, as thus caused, may be a 
simple, painless flow of water washing out the contents of the 
intestine, and making two or three or half a dozen liquid passages, 
or it may be a persistent depletion, reducing the system to an 
alarming degree. 

But diarrhoea originates also in other ways, especially by any 
irritation in the intestines themselves. One of the commonest 
causes of irritation is the presence of undigested food. If the 
stomach is feeble or out of order, or indisposed from any reason to 
perform its ordinary duties, and a meal is taken, this meal is not 
digested, and its substance passes into the intestine much as it was 
taken. Here it is a foreign substance, and disturbs accordingly, 
exciting free secretion, which washes out the offending material. 
Another source of diarrhoea is the reciprocal action between the 
skin and the intestinal mucous membrane, by which the application 
of cold to the surface of the body induces an undue activity of the 
bowels. Another very common cause of diarrhoea is constipation. 
This may result from carelessness in regard to the evacuation of the 
bowels, or from a flaccid condition of the bowels (see Constipation). 
The fecal substance remaining in the intestine irritates, and thus 



150 DISEASES OF DIGESTIVE ORGANS. 

causes diarrhoea. Many persons never have their bowels moved in 
any other way but by a diarrhoea thus caused, and alternate 
through their lives in periods of one or the other of these unnatural 
conditions. Diarrhoea is also a symptom in some grave diseases, 
especially in fever. In these several cases the stools will vary in 
hue from light yellow to green, or brown, and may be quite color- 
less and slimy. 

It is important to keep in mind the several causes of diarrhoea, 
and to endeavor to associate each case with its cause, for, according 
as it depends upon one or another of the several causes, the treat- 
ment must vary. 

In the painless diarrhoea that comes in hot, oppressive weather, 
and which cannot be traced to any offending article of food, the in- 
testinal circulation is at fault in the manner indicated above. This 
may induce two or three liquid passages, and be heard of no more, 
and it is well to wait for this possible result ; but, if the derangement 
persists, it is to be treated by any means that will naturally stimu- 
late the abdominal organs, especially the liver. Men in the army, 
prostrate with this diarrhoea, have been cured by the sudden neces- 
sity to mount their horses and meet the enemy. So men in our 
cities sometimes leave home in the morning to answer urgent re- 
quirements of business, hardly believing that they can get through 
the day ; but the enforced activity cures them. As, however, the 
idea of taking exercise while suffering from a diarrhoea is so con- 
trary to common prejudice that many cannot be induced to believe 
it right, medicines will be necessary. The simplest are the best. 

If a person is in the habit of taking mercurials, and believes that 
his liver cannot be stimulated in any other way, he may take from 
two to five grains of calomel, according to habit and strength, and 
take after it a small dose — half an ounce — of castor-oil; but ten 
grains of rhubarb in powder, without mercurials, will be quite as 
effective in the great majority of cases, and less likely to make an 
undue impression. If rhubarb gripes, from twenty to forty drops 
of paregoric may be added. 

In endeavoring to avoid the use of medicines in these cases, it 
should be remembered that even good things may be overdone. 
We may go too far with this care, and in certain seasons the flow of 
water from the bowels, beginning as we have indicated, may run 
into a disease of a choleraic character. Never let the discharges 
pass beyond control. If the frequency of the passages or the quan- 
tity of water evacuated is such as to alarm the patient, that alarm 
itself may lead to greater evil. Check the discharge, therefore, with 
the following mixture : 



CHRONIC DIARRECEA. 151 

Tincture of opium, 1 drachm. 

Tincture of capsicum, 1 drachm. 

Camphor-water, 1 drachm. 

Give, according to age, from ten to thirty drops after each 
passage. An ordinary teaspoonful of this mixture would contain 
twenty drops of laudanum, and this would be a pretty full dose for 
a grown person. Do not let a panic eagerness to arrest the 
diarrhoea hurry you into a too free use of the narcotic. 

Diarrhoea resulting from the action of cold on the surface, as in 
sudden changes of temperature, or with wet feet, must be treated by 
restoring the perspiration. It is best to go to bed, or to be wrapped 
in a blanket ; have warm applications made to the whole surface of 
the abdomen, as flannels heated at the fire, and take warm, cordial, 
diaphoretic draughts, which may vary with the taste, from ginger- 
tea to wine or brandy punch. If any medicine is taken to act on 
the bowels in these cases, it should be castor-oil only. 

Diarrhoea, induced by the presence in the intestine of un- 
changed alimentary matters, may result from the indigestion of a 
single meal, or from dyspepsia. If it is the former, it will cure 
itself, or the cure may be assisted by any medicine that gives two 
or three easy passages ; a dose of two or three of the compound 
cathartic pills will suffice. The same is true if the trouble results 
from an established dyspepsia ; but it is then scarcely worth while 
to go on treating as distinct troubles every recurrence of the 
diarrhoea. It will come too often, and the more medicine is taken 
for the diarrhoea, the more firm will become the hold of its cause. 
We must treat the dyspepsia (which see). 

Cholera morbus is an irritation of the intestines, caused by im- 
proper articles of food, and characterized by excessive pain. It is 
therefore essentially identical with diarrhoea, and must be treated in 
the same way. The vomiting is due to the fact that the excitement 
is transmitted upward to the stomach. 



CHRONIC DIARRH(EA. 

This may result from the simple derangement treated above, or 
it may have other causes. If a common diarrhoea is permitted to 
continue indefinitely, or if a person is living in such circumstances 
as to keep one up, or to constantly give a fresh one, as the other 
seems to have run its course, there id no return to the natural se- 
quence of events in the functions of the intestine. The exceedingly 
delicate surface that lines the intestinal tube is kept in a constant 
state of irritation. It loses its strength and tone — becomes feeble 
11 



152 DISEASES OF DIGESTIVE ORGANS. 

and soft. The innumerable little glands never perform their various 
offices ; the excitement keeps up a continual hyperemia, and, as 
the power of resistance passes away, all this leads to ulceration, and 
ulceration itself to still other troubles. Here there is such a compli- 
cation of evils that it is scarcely safe to trust to remedies prescribed 
on general principles. 

An efficient remedy is the solution of nitrate of iron, in doses of 
from ten to thirty drops, three times a day, with or without ten 
grains of powdered kino, taken in water. 

DYSENTERY— BLOODY ELUX. 

There is a sudden desire to empty the bowels out of the ordinary 
time, and this is followed by shivering ; heat ; thirst ; flatulence ; 
frequent inclination to action of the bowels, attended with straining, 
and preceded by griping ; loss of appetite ; nausea ; vomiting ; 
rapid pulse ; urine scanty and high-colored. The evacuations be- 
come scanty, relaxed, mixed with mucus, matter, and blood. If the 
disease becomes chronic, emaciation and debility follow, with fever 
of a low or typhoid character. 

It is distinguished from diarrhoea by the scantiness of the evacu- 
ations, the violence of the straining, and the presence of fever. 

Diarrhoea is apt to become dysentery. 

Causes — 1. Predisposing. — Hot climate ; cold and variable 
weather after prolonged hot and moist seasons ; debilitated habit of 
body ; deficient and unwholesome food ; impure air, and fatigue. 

2. Exciting. — Exposure to cold ; damp clothes ; sour or unripe 
fruit ; tainted food ; intemperance ; and contagion. 

Give, immediately, to an adult, thirty drops of laudanum, fol- 
lowed, in fifteen minutes, by one drachm of the powder of ipecac, in 
water. There will be profuse vomiting, and the ipecac, will move 
the bowels, and the patient will be better. Often one dose cures, 
but another may be necessary the next day. 

In some cases, where the fever continues high, and the tongue 
foul, a dose of calomel, ten grains, may be necessary. Give opium 
with this in free, full doses, so as to check the passages. Give one 
grain once in three hours. Injections will be necessary, of starch 
and water. Cold water is best. Put ten or twenty grains of ipecac, 
in this, and as many drops of laudanum. 

The horizontal posture and perfect rest must be constantly ob- 
served, and the greater the irritation the more requisite they are. 
The patient ought not to give way to the frequent inclination to 
stool, but resist it as much as possible. The stools must be imme- 



COLIC. 153 

diately removed from the patient's chamber, which should be freely 
ventilated at all times, and frequently sprinkled with vinegar. In 
malignant dysentery, the patient should void his motions into a 
vessel half full of water, to which a teaspoonful or two of the con- 
centrated chloride of lime have been added. This removes all smell 
instantly, and destroys infection. In such bad cases, the diluted 
chloride must be sprinkled over the apartment twice a day. It is 
advisable also to bury the motions when the disease is malignant, as 
the effluvia arising from them have been known to give the disease 
both to men and animals, even after they have been deposited in 
the usual receptacle. The " earth closet " is an excellent article for 
the use of patients with this disease. 

During convalescence, flannel should be constantly worn next 
the skin, and the most scrupulous attention be paid to avoid dews, 
damp night-air, and sudden atmospherical vicissitudes, more espe- 
cially in hot or unhealthy climates ; and no article of diet difficult 
of digestion must be touched. 

After leaving off other medicines, the patient should take an infu- 
sion of calumba or quassia, with or without a little nitrous acid and 
opium, to give tone to the bowels, which should be continued till 
they have recovered their vigor. 

Chronic dysentery is a consequence of protracted diarrhoea, and 
the only remedies are astringent tonics, of which the tincture of the 
chloride of iron is best. Give twenty drops three times a day. 

COLIC. 

This is marked by severe griping and twisting pains in the bow- 
els ; flatulency ; vomiting ; costiveness. The pains are intermittent, 
sometimes going off entirely, and are relieved by steady, firm press- 
ure. The tongue may or may not be furred. The pulse is not 
usually accelerated at first, or unless the attack be severe. In some 
severe cases the action of the bowels becomes reversed, and vomit- 
ing of faeces takes place. This form is called ileits, or iliac passion. 

Distinctive Symptoms. — Colic may be mistaken for inflamma- 
tion, and inflammation for colic. In inflammation of the bowels, 
pressure aggravates pain rather than relieves it, as in colic ; the 
pain comes on gradually, and is more constant; the pulse is sharp 
and frequent ; there is more or less fever. Costiveness from spasm 
of the bowels is often one of the first signs of inflammation of the 
bowels — and colic may also lead tb inflammation. Nevertheless, 
the treatment for colic may safely be adopted when the symptoms 
indicate it. Hernia, or rupture, in a state of " strangulation," may 
be overlooked, and taken to be colic. 



154: DISEASES OF DIGESTIVE ORGANS. 

Causes. — Severe spasm of the muscular fibres of the bowels, in- 
duced by exposure to cold; costiveness; indigestible food; acid 
and imperfectly-fermented beverages, as wines, spirits, cider, etc. ; 
injudicious use^of purgative medicines ; poisonous fungi, fish, etc. ; 
metallic poisons, as lead; irritation of teething in children. In the 
iliac passion, or the stercoraceous colic, the movements of the in- 
testines being reversed, a lower portion thereof sometimes slips into 
that above it, and causes what is called intussusception, a physical 
obstruction to the passage of the contents of the bowel. In children, 
however, this not infrequently happens, and rights itself, or exists 
without producing symptoms. 

Treatment. — 1. In Common Colic from Cold or Costiveness. — 
Fomentations of hot water, with turpentine ; or mustard-plasters to 
the abdomen. If these and the medicines do not quickly give relief, a 
hot bath of 90°, raised gradually to 110°, should be used. For an 
adult, take of castor-oil one ounce, laudanum twenty to forty drops, 
according to the age, and severity of the pain. If need be, repeat 
every two hours, for three times. Assist the action of these by 
glysters of turpentine and castor-oil, adding, if the pain continues 
severe, thirty or forty drops of laudanum to each. 

2. If the colic be traceable to sour beverages, unripe fruit, poi- 
sonous fish or fungi, or other indigestible food, let an emetic of mus- 
tard or ipecacuanha be taken immediately ; at the same time fomen- 
tations or a hot bath may be employed ; then follow up by castor-oil, 
as above ordered. 

3. In painters^ colic, or that from lead-poisoning, give at once 
thirty or forty drops of laudanum, hot bath, etc., then a mixture of 
Epsom salts and alum, and opium. 

4. In the colic of infants and children, give warm cordial magne- 
sian or antacid mixtures. The essence of anise-seed is a good prepa- 
ration, in from one to ten drops, according to age. 

N. B. — Be very careful in giving opium to young children. 

WOKMS. 

Several kinds of worms infest the intestinal canal. Those most 
generally found there are the ascarides, small thread-worms, vary- 
ing from the eighth of an inch to one and a halj: inches in length ; 
they are mostly in the rectum, or last gut. The lunibrici are long 
round worms, from two to three to ten or more inches in length ; 
they are of a yellowish- white, or brownish-red color, and are usually 
found in the small intestines. The tcenia, or tape-worm, occupies 
mostly the upper part of the intestinal tube, but is occasionally 



WORMS. 155 

found in every part of it. There are two sorts of taenia ; one, the 
commonest, frequently grows to an enormous length (as much as 
thirty or forty feet), and generally comes away entire; the other 
passes off in one or more joints, which resemble pumpkin-seeds. 

As may be expected, from the highly-organized and sensitive 
parts which they occupy, worms cause great constitutional de- 
rangement, resulting in all kinds of bad symptoms, more especially 
affecting the stomach and head ; hence we have in these cases varia- 
ble appetite, sometimes deficient, at others absolutely voracious ; 
pains in the stomach, foetid breath, nausea, headache, vertigo, and 
giddiness, irritation about the nose and anus ; frequently cough and 
disturbed rest, and a disordered state of the bowels. In children 
we have a hard and tumid belly, with slimy stools, and sometimes 
convulsive fits. Occasionally in adults, as well as children, worms 
give rise to epileptic fits, and cause great emaciation. 

An excessive use of fruit and vegetables, or sugar, or any other 
highly-nutritive substance, favors the generation of worms, which 
most frequently infest those of a relaxed habit, with weak digestive 
organs ; the greater indulgence in sweets, and too common abstinence 
from salt, appear to be the main reasons why children are most 
troubled with them. 

Worms are more common in some countries and districts than 
others, and it has been noticed that they are particularly so in parts 
where much milk and cheese are taken. Eating meat in a partially 
raw state, especially pork, will be pretty sure to produce them. 

Treatment. — This must be of a tonic and strengthening char- 
acter ; such medicines as tend to invigorate the system are the best, 
and especially those which act upon the stomach and intestines ; 
salt, preparations of iron, sulphur, and camphor, are those which 
may be principally depended on, in conjunction with an avoidance 
of vegetable and saccharine food. About one ounce of common salt 
dissolved in nearly half a pint of water, and taken in the morning 
fasting, twice a week for some little time, will generally bring away 
any kind of worms, if the plan is followed out, especially if a pill 
containing one grain of calomel and three of extract of colocynth be 
taken at bedtime the previous night. At the same time should be 
taken a strengthening mixture, composed of sulphate of iron, twelve 
grains ; infusion of quassia, twelve ounces ; tincture of ginger, two 
drachms. Dose, two tablespoonfuls twice a day. Or else, sulphate 
of iron and quinine, each twelve grains ; dilute sulphuric acid, 
twenty-four minims ; cinnamon- water, twelve ounces, dose as 
above. 

For the tape-worm, castor-oil and spirits of turpentine are often 



156 DISEASES OF DIGESTIVE ORGAN'S. 

given; about half an ounce of the latter, and two drachms of the 
former, is the dose; it should be taken fasting, and may be repeated 
two or three times, at intervals of two or three days or so. t Pome- 
granate-bark is a very old and useful remedy for this kind of worm ; 
the mode of administration is to boil two ounces of the bruised bark 
in one and half pints of water down to a pint, the whole of which is 
to be taken in the course of the morning fasting, in four draughts, 
with intervals of half an hour between each. Should this not be 
effectual the first day, it may be repeated two, three, or even four 
times. 

Another remedy for tape-worm, and perhaps more effective than 
any, may be made from the seed of the common pumpkin. Bruise 
a handful of the seeds, and steep them for some hours in a quart of 
water. Drink this mixture in two doses in the morning, fasting. 

An effective remedy also is to .take by the mouth one drachm of 
sulphuric ether, and in half an hour a dose of castor-oil. The ether 
stupefies the worm, who loses his hold, and is carried out alive by 
the oil before he recovers. 

COSTIVENESS. 

Constipation of the bowels is a fruitful source of many com- 
plaints, as dyspepsia, piles, fistula, strictures of the rectum, general 
debility, lowness of spirits, headaches, and various other evils. The 
bowels are organs so sensitive and important, that it should never 
be forgotten that habitual constipation necessarily produces dis- 
order, and disorder leads to disease ; and the correction of this habit, 
therefore, deserves far more attention from the subjects of it than it 
commonly obtains. The most pleasant and effectual way of correct- 
ing it is by draughts of cold water ', diet, friction, exercise, and the 
occasional use of the lavement or clyster-tube, if necessary ; but this 
I believe will be seldom requisite. It is an unwise and unsatisfac- 
tory plan for the constipated to trust chiefly or altogether to the 
frequent use of aperient medicine ; this now and then employed is 
sometimes of great service, but the relief gained by cold water, a 
vegetable and fruit diet, friction, and the occasional injection, is 
more certain, permanent, and beneficial. 

In point of diet, great attention should be paid in avoiding all 
articles that are astringent, and in indulging moderately in those 
which are relaxing. Generally speaking, the patient will find that 
excess of diet will increase the costive habit, by disordering and 
still further weakening the bowels. The constant use of brown in- 
stead of white bread is a measure that will frequently overcome this 
habit, when aperient medicine is resorted to with only partial &?. 1 



PILES. 157 

unsatisfactory benefit ; and if, after a time, it should lose its effect, 
it may be alternated with bread made of one-third or one-half rye- 
flour, mixed with the wheaten-flour. Barley-bread also has consid- 
erable effect in promoting a soluble state of the bowels, and so has 
barley-meal porridge. It is easily digested, and very wholesome. 
Active exercise in the open air should be freely employed, with daily 
friction over the region of the stomach and bowels. 

Constipation is in many cases due to neglect. Persons do not 
attend to the first call of Nature, or they may be so excited in other 
pursuits, that the nerves that should give the warning are at fault. 
In such cases, which certainly are very numerous, the simple turning 
the thought to the subject, or the spending an hour, if necessary, 
every day at the same time in the appropriate place, will prove a 
complete cure. 

Where all such efforts fail, use a pill composed as follows : 

Kesina podophyllum, 2 grains. 

Powder of rhubarb, 8 grains. 

Mix, and make eight pills. Take one a day. 

This is too small a dose of medicine to do any harm, even contin- 
ued for some time, but it will be effective. Or those whose stomachs 
do not rebel at castor-oil may adopt the following plan : Take on the 
first day a sufficient dose of oil, say an ounce — on the next day half 
an ounce. Keep at this dose two or three days, and then take a 
quarter of an ounce, then a teaspoonful, then half a teaspoonful, and 
so down. Persons have by this plan been able to keep their bowels 
open by the daily use of a few drops of oil. 

PILES. 

Piles consist in a distention of the veins of the rectum, or in a 
relaxation of the surrounding skin and cellular substance, with an 
effusion of blood into it, forming small tumors, either within the 
anus or at its verge, or sometimes producing one tumid ring, by 
which it is surrounded. 

In some cases, they are attended with a discharge of blood, par- 
ticularly when the patient goes to stool, called the bleeding or open 
piles ; in others there is no discharge, when they are denominated 
the blind piles. Sometimes they are situated within the gut, and 
obtain the name of internal piles, but more frequently they pro- 
trude beyond the anus. 

They are sometimes preceded by a sense of weight in the back, 
loins, and bottom of the belly, together with uneasiness of the stom- 



158 DISEASES OF DIGESTIVE ORGANS. 

ach, and flatulency in the bowels ; on going to stool, a pungent 
pain is felt in the fundament, and small tumors are found to project 
beyond its verge. If these break, a quantity of blood is voided, 
and considerable relief from pain is obtained ; if they continue un- 
broken, the patient experiences great torture every time he goes to 
stool, and feels an inconvenience when sitting down on any hard 
seat. Sometimes incontinence of urine accompanies the complaint. 

Frequently, however, the symptoms are not so severe as this, but 
are, notwithstanding, very troublesome, as the patient is, from time 
to time, annoyed by a relaxation of the skin about the anus, and the 
formation of a small tumor, which is apt to increase, and be very 
painful when the patient is walking or standing long. The tumor 
will sometimes bleed, at other times it will not. 

Piles which bleed but little are not of much consequence ; but 
those which bleed profusely, cause violent pain, or induce inflamma- 
tion and its effects, demand the greatest attention. 

Piles, if attended to at the beginning, are always curable. They 
are a consequence of disorder of the liver. We have hitherto de- 
scribed how the blood from the intestine passes through the liver 
on its return to the heart, and it will readily be understood that a 
disorder of the liver, that deranges the passage of the blood through 
that organ, dams the stream below. Thus stayed in its course, the 
stream flows slowly through the veins ; the veins always contain an 
unnatural quantity of blood, and the tumors of piles are these 
swollen veins, or the tissues near, swollen by the blood forced 
through the walls of the vessels. 

Treatment. — Give an adult five grains of calomel, and in three 
or four hours the following : 

Sulphur, 1 drachm. 

Cream of tartar, . 20 grains. 

Water, 2 ounces. 

Mix for one dose. 

Repeat this plan two days, and, after that, as the obstinacy of 
the case may require. Bathe and cleanse the part every night and 
morning with soap and water. 

In all cases of piles, the pain or irritation is much relieved by 
the free application of cold water on a cloth bound to the part, and 
that should be changed as often as the water becomes warm. If the 
heat and irritation are very severe, the immersion of the parts in a 
hip-bath of cold water should be resorted to, and will afford relief. 

Prevent a recurrence of this trouble by the use from time to 
time of mildly-purgative medicine, as rhubarb. 



DESCENT OF THE RECTUM— RUPTURE. 159 

'DESCENT OF THE RECTUM. 

In this the rectum comes down through the anus, generally by 
forcing: at stool. The cause is a want of tone in the intestine itself. 
The part must be restored carefully with the hand, guarded with a 
greased cloth, and applications kept on of compressors wet with 
cold water. An injection of alum- water may also be used to give 
tone. The bowels should be kept in such state that the passages 
will never be hard. 

This trouble will sometimes result from the irritation of stone in 
the bladder . 

RUPTURE. 

In this, some portion of the intestine is forced outward, through 
natural openings in the inner division of the abdominal wall. The 
gut may pass down on the inner surface of the leg, follow the great 
artery, or it may come through at the junction of the thigh and 
belly, or at the navel. 

A swelling, small at first perhaps, is found in one of these places. 
It is not painful, nor are there signs of inflammation about the spot ; 
if it recedes on pressure, or on a recumbent position being assumed, 
the patient may be pretty sure that it is a rupture ; if, on pressing 
it back, there is a gurgling noise, it contains intestine only ; but, 
when omentum also is projected, there will be a solid, doughy kind 
of feel. Persons are often ruptured for some time without being 
aware of it. They will perhaps experience uneasy sensations about 
the pit of the stomach, a kind of dragging, with slight nausea ; on 
their having occasion to make some great exertion that hitherto un- 
discovered lump will become more prominent, and force itself upon 
the attention, and there may, or may not be, sickness and vomiting 
until it is returned into the abdomen, which it generally can be with 
a little careful manipulation. The object, then, is to secure such an 
amount of pressure over the orifice of escape as to prevent its pro- 
truding again, and this can only be done by a truss of some kind. 
The patient is never safe without one ; and, as it is of the utmost 
consequence, both to the comfort and safety of the wearer, that the 
instrument should be exactly suited to the case, it is best to resort 
at once to an experienced surgical-instrument maker. 

The part should be sponged night and morning with cold water, 
and, if it gets chafed or abraded, it should be dusted after each 
sponging with starch-powder or flour. A regular action of the 
bowels is essential to the safety of ruptured persons, as the violent 
medicines necessary to relieve a state of costiveness will be likely to 



IQQ DISEASES OF DIGESTIVE ORGANS. 

increase the rupture to a dangerous extent. Castor-oil, or some 
other gentle aperient, should be taken as often as may be necessary 
to insure a daily motion without much straining. 

One of the tendencies of this affection is to cause a deficient ac- 
tion of the bowels, and when these are much confined, and there is 
a sense of constriction about the middle, and vomiting of feculent 
matter, an examination should always be instituted, to ascertain if 
rupture has not originated this train of symptoms. It may happen 
with ruptured persons who do not wear a truss, and also with those 
who do, if the instrument is not quite suited to the case, 'that the 
protruding gut or omentum may become so large that there is much 
difficulty in getting it back, or reducing the rupture, as we should 
say ; if the patient cannot, by lying down on his back, and gently 
pressing it up through the aperture, accomplish this, the aid of a 
surgeon should be obtained, if possible ; should it not be, a warm 
bath may be first tried, keeping the patient in until he feels faint, so 
as to relax the muscles ; he should, during this time, repeatedly re- 
new the efforts above directed. If this fails, apply pounded ice in 
a bladder to the part, or a freezing mixture, composed of table-salt, 
saltpetre, and sal-ammoniac, in equal proportions, with a little water 
added, just enough to make it liquid. If neither of these can be 
readily obtained, intense cold may be produced by means of wet 
rags laid over the swelling, and evaporation encouraged by a con- 
tinual stream of air from a pair of bellows directed upon the rags, 
which should be continually rewetted. 

Sometimes, the return of the rupture may be accelerated by a 
reversal of the position of the body, placing it on an inclined plane, 
with the head downward. Bleeding to faintness while standing 
up, and then lying down, has sometimes succeeded, but, of course, 
only a surgeon could attempt this. Should all means fail, we have 
what is called strangulated hernia, and an operation is necessary ; 
this is always attended with considerable danger. "When rupture 
of the groin occurs with young children, nothing can be done for 
the first three months or so, but to keep the child as much as possible 
in a recumbent position, and sponge the part frequently with cold 
water ; at the end of the above period a light truss may be worn 
with every prospect of a cure, if proper attention is paid to the case. 
When a person about forty years of age becomes ruptured, there is 
little chance that a cure will be effected, although by constant press- 
ure on the part, with an avoidance of violent exertion, the size of 
the rupture may be greatly reduced. 



FISTULA. 161 



FISTULA. 



Fistula in ano is the disease that is generally understood by 
the term fistula, used by itself. In this there is a passage or sinus 
that runs by the rectum, the inner opening of which is in the wall 
of the rectum, and the outer, if it have one, near the anus. Some- 
times the passage runs up close to the interior, but does not open 
into it. There is commonly intense pain with fistula, and an inabil- 
ity to move about. Domestic treatment will do little for it. If 
there is an external orifice, it can be kept open by means of twisted 
lint passed deeply in ; but most commonly an operation is required, 
which, although sharp, is short in its continuance ; it consists in 
making a complete division with the knife of the whole of the parts 
between the fistula and the bowel. After this the cure is generally 
effected without much difficulty ; the spasmodic pains, nearly always 
felt, are at once relieved, and the constitutional derangement gradu- 
ally passes away. 

No medical treatment promises any benefit except the local use 
of a strong solution of krameria. Inject the solution several times 
a day. Good results have been obtained in this manner. 



DISEASES OF THE UKINARY AND GENITAL 

OKGANS. 



INFLAMMATION OF THE KIDNEYS. 



There are pains in the loins, aggravated by pressure, by sneez- 
ing or coughing, or by a sudden movement ; and pain extending 
through the abdomen, and attended with numbness down the inside 
of the thighs and testicles. Urine is frequently voided, with great 
pain, and is high-colored, sanguineous, or dark-brown. Shivering ; 
nausea ; vomiting ; bowels confined ; frequent and sharp pulse ; skin 
hot and dry ; fever, varying in severity according to the acuteness 
of the attack. The disease will present several degrees of severity 
down to the chronic state ; its duration will vary from a few days 
to many months. 

If the inflammation be not subdued, the constituents of the urine 
become absorbed into the circulating blood, and the patient be- 
comes poisoned thereby. The extremities lose their warmth, the 
pulse fails, the muscular power sinks, delirium comes on, and the pa- 
tient dies in lethargy or convulsions. 

Causes. — Disorders of the digestive organs; gouty or rheumatic 
affections; blows; injuries on the loins ; too long retention of urine ; 
improper use of irritating diuretics ; gravel or concretions in the 
kidneys; suppressed perspiration ; cold; eruptive fevers. 

Treatment. — For the acute attack, caused by cold or by injury, 
leeches applied freely to the loins, followed by warm fomentations or 
poultices ; calomel and opium ; tartar-emetic, and purgatives ; give 
three grains of calomel and one of opium, repeated as the severity of 
the symptoms urges. The tartar-emetic should be in the following 
mixture : 



DIABETES. 163 

Solution of acetate of ammonia, 2 ounces. 

Powdered nitre, •£ drachm. 

Tartar-emetic, -J grain. 

Water, 4 ounces. 

Give two tablespoonfuls every few hours. 

For the less severe attacks, give salines, diaphoretics, warm bath 
and local fomentation. 

DIABETES. 

The characteristic symptom is a frequent and copious discharge 
of urine, several gallons being sometimes passed in a day. 

This disease comes on insidiously, and is generally not noticed 
until it has existed some time. It is attended by constitutional 
symptoms, which are at first slight and indefinite, but after a while 
become distinct and urgent. These are — debility ; dryness of mouth 
and throat ; loss of flesh ; great thirst ; a dry, red tongue ; increased 
appetite; costiveness; pains in the loins and pit of the stomach; 
chilliness. As the disease advances, all these symptoms become 
greatly aggravated ; the spirits become depressed, or the mind anx- 
ious, listless, weak, or peevish ; the legs swell, and the patient sinks. 

Diabetes indicates grave disorder of the kidneys and digestive 
organs. Its common causes are intemperate living, excess of venery, 
copious evacuations of the bowels, long continued, frequent use of 
diuretics and acrid drinks, or it may be hard labor and poor living, 
or aught which tends to impoverish the blood. The physiological 
starting-point is an impaired action, or morbid change, in the nat- 
ural powers of assimilation and digestion. It was formerly regarded 
as invariably fatal. As, however, the condition of the urine in 
disease is now more accurately investigated, the presence of sugar 
in the urine is found frequently to be a temporary occurrence. 
Diabetes is also now more readily detected in its early stages. In 
order to attain this object, so important to efficient treatment, we 
give the following tests : 

1. Pour a few drops of the suspected urine on a white plate, 
placed near a fire, or on a stove ; while warm, drop a few drops of 
strong sulphuric acid, and continue the heat. If the urine contain 
sugar, the spot where the acid comes in contact with the urine will 
first become deep brown, then black, by the charring of the sugar. 
If no sugar be present, the mine is changed to a pale-orange color. 

2. Place a small quantity of the urine in a test-tube or watch- 
glass ; add half its quantity of strong solution of potash ; heat the 
mixture carefully over the flame of a spirit-lamp ; and the pale mix- 
ture will become of a deep-brown color, with a cloud of sediment. 



164 DISEASES OF THE URINARY AND GENITAL ORGANS. 

3. Add a little yeast to the urine, and expose it to a temperature 
of about 80° ; the mixture will soon become turbid, and ferment, pro- 
ducing a frothy scum having a vinous odor. 

4. Allow the urine slowly to evaporate for some time by a gentle 
heat, and a treacly liquid, or syrup, will be formed. 

There are other more exact tests than these, but they are com- 
plicated, and cannot be undertaken by persons unacquainted with 
chemistry. At the commencement of the disease, however, and 
when the flow of urine is much in excess of the natural quantity, 
there may be no sugar in it — the presence of sugar indicating a 
further progress of the disease and greater disturbance of the 
nutritive functions. 

Treatment. — The diet should be entirely animal food — all vegeta- 
ble substances to be avoided — the bowels to be kept quietly open with 
pills of aloes and soap, emetics and diaphoretics occasionally admin- 
istered; perhaps the compound ipecacuanha-powder, ten grains at 
bedtime, is the- best; alkaline drinks, such as soda-water, may be 
given with advantage, and blisters and issues applied to the regions 
of the kidneys, covering the skin with flannel, anointing it with cam- 
phorated oil; using the warm bath and the flesh-brush are also 
good, as are chalybeate and sulphurated waters. Tonics, astrin- 
gents, and stimulants, will be of service, especially preparations of 
iron with tincture of cantharides ; if in the summer, sea-bathing, 
and any thing which may serve to invigorate the system: such is 
an outline of general treatment ; of course, constitutional peculiari- 
ties require special and appropriate remedial measures. 

Trousseau, the great Paris physician, recommended for this 
disease medicines to act especially on the nervous system. He gave 
large quantities of the tincture of valerian, but later experiments 
seem not to obtain the success he claimed. 



BRIGHT'S DISEASE. 

This is a disease of the kidney, the distinguishing peculiarity of 
which is the presence of the serum of the blood in the urine, the 
albumen of which coagulates on the application of heat ; there may be 
only sufficient to cloud the fluid, or enough to form nearly a solid mass. 
The causes of this disease, which was first described by Dr. Bright, 
of London (hence its name), are various ; it may be severe cold, 
repressed perspiration, or immoderate use of ardent spirits ; and it 
not uncommonly follows scarlet fever ; any thing that may excite 
and keep up inflammation may lead to the change of structure that 
marks this disease. It is usually accompanied by febrile symptoms, 



REXAL COLIC. 165 

and dropsical swellings of the face and extremities, and eventually 
of the body also. There is a bloated expression of countenance, 
with singular pallor, and there is swelling of the feet and ankles; 
also persistent headache and dyspepsia ; and in some cases diarrhoea 
and vomiting. 

All these indicate such a change in the kidney as to prevent the 
performance of its function — the kidney cannot carry out the water 
properly, and the system becomes dropsical; it decomposes the 
blood, and the nutrition fails ; it does not carry from the blood cer- 
tain poisons that are in it, and these, remaining, disturb the nervous 
system, producing headache, vomiting, and eventually more or less 
paralysis, stupor, and perhaps convulsions. 

Teeatatext. — In the early period of the disease, before the in- 
flammation has induced changes in the organs, treat it actively by 
cups to the loins, hot baths, and purging, with calomel and jalap, ten 
grains of each, for two or three days successively. Stimulate the 
skin, that the kidney may be relieved of its labor and have rest ; 
give the liquor of acetate of ammonia freely. If the urine is still 
found to contain albumen, after effectual trial, the best that can be 
done is to supplement as far as possible the action of the kidneys 
by constant stimulation of the bowels and skin. Purge every 
other day actively with the compound powder of jalap, and keep up 
a liberal perspiration with acetate of ammonia, hot baths, or any 
other effective means. 

"Where there are convulsions, give the bromide of potassium in 
doses of twenty to forty grains, repeated as the occasion may 
require. 

REXAL COLIC. 

This occurs when a stone formed in the kidney is impelled down 
the narrow passage that leads from this organ to the bladder. 
There is no symptom but pain — and pain of the most terrible char- 
acter. Nothing can be done but to give opium. Death may be the 
result of this trouble, when the stone is too large to pass. 

Cancer occurs in the kidney, and may generally be recognized 
by frequent recurrence of passage of blood in the urine, coinciding 
with a tumor in the abdomen. This disease is but little susceptible 
of treatment, and least of all domestic treatment. Relieve pain 
with opium, and relieve the kidneys by stimulating the skin. 

INFLAMMATION OF THE BLADDER. 

This may be either acute or chronic. In the first there are severe 
pain, often of a burning character, with tenderness at the lower part 



166 DISEASES OF THE URINARY AND GENITAL ORGANS. 

of the stomach and body, in the loins and down the thighs ; frequent 
occasion to void urine, which is passed with difficulty and great 
pain, in small quantities ; confined bowels ; restlessness ; hot skin ; 
rapid pulse ; fever ; and the urine is high-colored, and cloudy with 
mucus. 

In the chronic inflammation there are the same symptoms in 
slighter d*egrees and less severity, but they continue. After the 
affection has lasted a few weeks, the urine becomes thicker, until it 
is sufficiently viscid to adhere to the sides of the utensil ; it then 
exhales a strongly ammoniacal odor. 

Distinguish this disease from spasmodic attack of gravel by the 
presence of fever, and the more sudden character of the seizure in 
paroxysms of gravel. 

Treatment. — Give at once about five grains of calomel, following 
it up with a rhubarb-draught, or some other mild aperient ; the ap- 
plication of leeches to the lower part of the abdomen, with the use 
of a warm hip-bath, to encourage the bleeding, the bath to be con- 
tinued daily, or twice a day, if necessary ; the use of diluents, such 
as barley-water, or linseed-tea, and abstinence from all stimulating 
drinks whatever. These means, with a rigidly-abstemious diet, and 
rest in a recumbent position, will generally reduce the inflammation 
in the course of a few days. Should they not, and should the patient 
be of a full habit of body, bleeding from the arm may be resorted 
to, and such other measures of depletion as may be necessary. The 
following is a good formula for a mixture : nitrate of potash and 
tincture of henbane, of each two drachms ; liquor of acetate of am- 
monia and mucilage of acacia, of each one ounce ; camphor-mixture, 
ten ounces. Take two tablespoonfuls every four hours. Injection 
of the bladder with warm water, or some emollient fluid, such as in- 
fusion of linseed, is sometimes resorted to with good effect. The 
suppression of urine, and consequent distention of the bladder, will 
sometimes cause inflammation of that organ ; or it may proceed 
from a calculus of considerable magnitude lodged within it. 

If the inflammation be chronic, leeches are seldom required ; in 
other respects the treatment must be much the same as that above 
recommended. When this treatment does not afford relief, and the 
urine retains its acid quality, which may be known by its turning 
litmus-paper red, two and a half grains of calomel, with three grains 
of opium, should be taken three times a day. If the urine is alka- 
line, and deposits mucus of a brownish color, the patient should take, 
with each dose of the above mixture, fifteen minims of wine of col- 
chicum. This is Sir B. Brodie's plan of treatment. Great care 
should be taken when the patient is recovering, as to the diet, and 



IRRITABLE BLADDER. 167 

mode of living ; a very slight excess in eating or drinking, or vio- 
lent exertion, may bring on a relapse. It is well to take, for some 
little time, one of the following pills, twice a week : blue pill, twelve 
grains ; ipecacuanha-powder, three grains ; acetous extract of col- 
chicum, six grains. Mix, and make into six pills. An aperient 
draught of compound infusion of senna, or of rhubarb and magnesia, 
should also be taken occasionally. 



IRRITABLE BLADDER. 

The patient is distressed by a frequent desire to void his urine, 
accompanied with great pain in the region of the bladder ; and, in 
the continuance of the disease, the former symptom becomes at 
length so urgent, that he cannot pass more than ten or fifteen min- 
utes without feeling the inclination. In this case, the bladder is the 
subject of chronic or slow inflammation, when the stimulus of the 
urine is such as to excite excessive pain, and an uncontrollable desire 
to part with it nearly as soon as secreted. Sometimes in this com- 
plaint the urine is mixed with blood ; and, should it go on to produce 
ulceration in the organ, there will be a discharge both of blood and 
mucus, and frequently of matter (pus). 

It may be distinguished from stone in the bladder, by observing 
that, in the latter complaint, severe pain is felt after the water is 
voided, while in irritable bladder its expulsion is always followed by 
considerable, and sometimes perfect, relief. 

Treatment. — The objects to be accomplished in this case are to 
keep the organ in a state of rest and ease, by constantly wearing a 
catheter ; and to allay pain and irritation by the internal use of al- 
kalies, combined with opium, occasional doses of calomel and opium, 
cupping on the loins, the warm bath, and warm fomentations, etc. 

When, therefore, a patient is suffering from irritable bladder, he 
should immediately have ten or twelve ounces of blood taken from 
the loins by cupping ; a blister should then be placed on the lowest 
part of the belly over the region of the affected organ, after the part 
has been shaved, and a grain of opium mixed with a grain of calo- 
mel, and made into a pill, be taken directly, and repeated every 
night, or twice a day if the symptoms are severe. Through the 
whole course of the complaint, the bowels must be preserved free 
from confinement by the use of castor-oil. 

To keep the bladder in a state of rest, a short flexible catheter 
should be introduced without delay, and constantly worn by the pa- 
tient until he has perfectly recovered. This instrument affords great 
ease, by allowing the urine to escape as fast as it is secreted by the 
12 



168 DISEASES OF THE URINARY AND GENITAL ORGANS. 

kidneys, thus keeping the bladder continually empty. The point of 
the catheter should only just enter the bladder, to accomplish which 
it is necessary to pass it to the extent of about nine inches, when, 
after the remainder has been cut off, its points should be tied to a 
bandage carried between the thighs and round the loins. As much 
quietude as possible must be observed. 

The foregoing means will afford immediate and sensible relief, 
and alleviate the acute symptoms, when the patient will act wisely 
to take twenty drops of the liquor potass w, with four drops of lau- 
danum, three or four times a day, in barley-water ; and this medicine, 
if it agrees, should be continued for a month or more, till the cure 
is established. As the patient recovers, the quantity of opium may 
be gradually lessened to one or two drops in a dose. 

Now and then the irritability of the urinary passage, as well as that 
of the neck of the bladder, is so great as to render it impossible to 
pass the catheter, without occasioning considerable pain, and subse- 
quent increase of the irritation for some days. This is a rare occur- 
rence, but, when it does happen, the catheter must be laid aside 
altogether, and the other means just noticed trusted to alone. 

When the case is of an aggravated nature, and the bladder has 
become ulcerated, the remedies will require a longer perseverance. 



INCONTINENCE OF URINE. 

This disease usually proceeds from relaxation or palsy of the 
sphincter muscle of the bladder, induced by debility, the abuse of 
spirituous liquors, excess in venery, etc.; or it arises from a peculiar 
acrimony in the fluid itself; from a diseased state of the organ, in- 
jury done to the parts, either by accident, by the process of ulcera- 
tion, or by the performance of the operation of lithotomy ; irritation 
produced by stones in the bladder ; or the pressure of the womb in 
a state of pregnancy. 

Treatment. — As the complaint commonly proceeds from de- 
bility, tonics and stimulants are generally -found, to be the most effi- 
cacious remedies ; such as bark, iron, turpentine, tincture of Spanish 
fly, copaiba-balsam, lime-water, and bear's whortleberry. The 
following prescriptions are sometimes very serviceable, and, should 
one fail, the patient can try another : 

Take of sulphate of zinc, 1 drachm. 

Common turpentine, 3 drachms. 

Rhubarb, in powder, -£ drachm. 

Mix, and make into sixty pills ; one to be taken thrice a day. 



STONE IN THE BLADDER. 169 

Take of tincture of Spanish fly, . . . . 15, 20, or SO drops 
Decoction of bear's whortleberry, . . 4 tablespoonfuls. 
Mix for a draught, to be taken three times a day. 

Take of balsam of copaiba, \ ounce. 

Frankincense, in powder, .... 2 drachms. 

Mucilage of gum-arabic, \\ ounces. 

Simple syrup, -J- ounce. 

Cinnamon-water, 5 ounces. 

Mix, and take three tablespoonfuls twice a day. 

At the same time that one of the above remedies is taken inter- 
nally, cold water should be freely applied locally ; and an occasional 
blister to the sacrum, or broad bone at the bottom of the spine, is 
frequently of material service. Five to ten drops of the tincture 
of belladonna, given at bedtime to boys who are apt to wet their 
beds, will often completely cure them of this incontinence without 
the use of any other remedy. 

Should the tonic plan fail in adults, it will be necessary to stimu- 
late the nerves, upon which the action of the sphincter of the blad- 
der depends. For this use the extract of belladonna. Give from a 
fifth to a tenth of a grain daily, in pill, increasing the dose till its 
effects on the system are evident. This medicine can scarcely fail. 

STONE IN THE BLADDEE. 

The symptoms are usually slow in development, and indefinite 
in character. Suspicion of the existence of a stone in the bladder 
should be excited by increased frequency of occasion to pass water, 
which is voided with difficulty, and in a broken stream; or, the 
stream, being entirely checked, flows again with a change of pos- 
ture. Stone in the bladder is also attended with pain in the course 
of the urethra, extending deep in the body, to the neck of the 
bladder. One of the most common signs of stone occurring in 
children is, that, to relieve this pain in the organ, they acquire a 
habit of pulling the foreskin, which thereby becomes elongated. 

When stone has been present in the bladder for some months or 
years, it gives rise to chronic inflammation of the bladder. 

These are the general symptoms of stone in the bladder : alone, 
however, they are not conclusive — they must be confirmed by the 
surgical operation of sounding, which consists of the introduction of 
a steel rod into the bladder, so that the stone shall be detected by the 
touch and hearing. The operation must be performed by a surgeon. 

Causes. — Concretion of earthy matter upon small fragments of 
gravel or other substances in the bladder. This complaint occurs in 



170 DISEASES OF THE URINARY AND GENITAL ORGANS. 

morbid conditions of the constitution, following gout, indigestion, 
etc. It frequently, however, takes place in children in whom these 
causes cannot have operated; it is, therefore, not always clear to 
what cause it can be attributed. 

Treatment. — The only complete cure for stone is to be sought 
in the removal of the concretion from the bladder. This can only 
be done by a surgeon. If symptoms of chronic inflammation of the 
bladder be present, relief may be obtained by the means recom- 
mended for that disease. Irritability of the bladder, denoted by 
frequent urgency to pass water, may be allayed by doses of solution 
of potash, or of tincture of iron, and tincture of henbane. Careful 
dieting should be observed, in order to avoid the causes of indi- 
gestion, etc. 

GRAVEL. 

Crystalline sediments deposited in the bladder from the urine 
constitute this disease ; when shapeless, irregular, and reducible to 
powder, they may be either red, or pink, or white. Into the compo- 
sition of the latter the phosphates largely enter ; the former consist 
chiefly of lithate of ammonia. When crystallized, they may be also 
red or white, the former consisting of crystals of uric or lithic acid, 
and the latter of triple phosphate of ammonia and magnesia. 
Although the deposits in gravel vary considerably in their form and 
color, and to some extent in their character also, yet the nature of 
the disease is essentially the same. If the deposited particles re- 
main stationary in the bladder for a length of time, others gather 
around them until they form a hard, solid mass or stone. 

The symptoms of an attack of gravel are constipated bowels, 
restlessness, and dry skin, with pains in the loins, commonly on one 
side, where it descends, following the course of the ureter; the 
thigh and leg feel numbed ; and sometimes in the male the testicles 
are drawn up. There is frequently sickness, and an urgent desire to 
make water, which is passed with difficulty, and is high-colored and 
turbid, depositing a sandy powder, which is sometimes red, at 
others white, or a mixture or alternation of the two colors, with 
occasionally a bloody tinge. Derangement of the digestive organs 
is common in such a case; there will probably be constipated 
bowels, with acid eructations, with great restlessness, and a sense 
of weight at the pit of the stomach. 

In cases of white gravel, an acid is the best medicine, and all the 
acids seem to answer the purpose, though the muriatic, nitric, and 
citric acids, have been in the greatest repute. The citric acid, or 
lemon-juice, is preferable for children, as being the pleasantest, and 



GRA YEL. 171 

that which may be persevered in for a considerable time ; it may be 
mixed with water in any proportion that is agreeable. The mu- 
riatic acid may be given in doses of from five to twenty drops, 
twice or thrice a day, in four tablespoonfuls of water; and the 
nitric acid in doses of from five to twelve drops, in the same pro- 
portion of fluid. Tonics, also, as quinine, bitter infusions, and 
decoction oipareira brava, are suitable. 

But the red gravel is by far the most frequent kind of deposit, 
and the most effectual remedies for it are the alkalies, and the alka- 
line carbonates, such as lime-water, the bicarbonate of potash or 
soda, magnesia, and lithia or potash- water. But, to be really useful, 
they must be conjoined with alteratives and aperients ; for it ought 
never to be forgotten, in the treatment of gravel and stone, that 
they owe their formation chiefly to a weakened and vitiated action 
of the digestive organs, which will invariably require this conjunc- 
tion, in order to the accomplishment of a permanently beneficial 
effect. 

Half a drachm of bicarbonate of potash, or soda, may be taken 
in infusion of cascarilla, or water, once or twice a day, and three 
grains of blue-pill every other night ; the following draught being 
taken every morning, or every other morning, as a gentle and suit- 
able aperient : 

Take of Rochelle salts, 2 drachms. 

Carbonate of soda, . . . . . 1 scruple. 

"Water, 3 tablespoonfuls. 

Mk, and, after adding a tablespoonful of lemon-juice, or thirty grains of 
tartaric acid, let it be drunk directly. 

Constant active exercise is of the first importance in all gravelly 
disorders ; and flannel should be constantly worn. Sailors, and 
other persons accustomed to constant and laborious exercise in the 
open air, are very rarely affected with these complaints. M. Ma- 
gendie, the celebrated Parisian physician, has given a striking 
example of the advantages to be derived from exercise and absti- 
nence, and the mischievous effects of luxury, in the case of a mer- 
chant of one of the Hanseatic towns. " In the year 1814, this gen- 
tleman," says he, " was possessed of a considerable fortune, lived in 
an appropriate style, and kept a very good table, of which he him- 
self made no very sparing use. He was at this time troubled with 
the gravel. Some political measures unexpectedly took place which 
caused him the loss of his whole fortune, and obliged him to take 
refuge in England, where he passed nearly a year in a state border- 
ing upon extreme distress, which obliged him to submit to num- 
berless privations: but his gravel disappeared. By degrees he 



172 DISEASES OF THE URINARY AND GENITAL ORGANS. 

succeeded in reestablishing his affairs ; he resumed his old habits, 
and the gravel very shortly began to return. A second reverse 
occasioned him once more the loss of all he had acquired. He went 
to France, almost without the means of subsistence, when, his diet 
being in proportion to his exhausted resources, the gravel again a 
second time vanished. Again his industry restored him to comfort- 
able circumstances ; again he indulged in the pleasures of the table, 
and had to pay the tax of his old complaint." 



INFLAMMATION OF URETHRA— GONORRHOEA— CLAP. 

The word gonorrhoea means literally involuntary emission of 
semen ; but it is always applied to a discharge of purulent matter 
from the urethra or vagina. The common English term for the dis- 
ease is clap. Gonorrhoea may be shortly described as a morbid 
discharge from the urethra, in consequence of impure connection ; it 
is, as Abernethy observes, " a mere local disease, not followed by 
any constitutional symptoms." It is a quite separate and dissimilar 
disease from the old lues, or venereal disease, of which it was long 
considered a modification. In this case, the gonorrheal poison, 
falling upon a mucous surface, produces from thence a discharge 
of infectious matter; in the other, the syphilitic poison applied to 
the skin, or, as it is believed, to any surface, produces ulceration 
and inflammation, forming a sore called chancre (see Syphilis). 

Symptoms. — Shortly after the infection has been communicated 
(it may be two or three days, or a week, or more), the patient expe- 
riences a sensation of heat, with tingling and uneasiness, about the 
orifice of the urethra; this is quickly followed by swelling and 
redness about the margin of the opening, and a slight mucous dis- 
charge ; then there is pain, and what is called ardor urine®, or scald- 
ing of the water ; then the discharge becomes yellow, thick, and 
looks like pus. 

As the discharge continues, the glands in the groin become en- 
larged and painful, and the feeling of weight in the parts is oppres- 
sive. ChOrdee occurs, when the inflammation, extending, touches 
parts that lead to erection, the erection being exceedingly painful in 
the inflamed state of the urethra. If the disease is neglected or un- 
controllable, the inflammation extends to the bladder and the sem- 
inal- organs, and leads to swelling of the testicles. 

Treatment. — Do not trust to the notion that a clap will wear 
itself out ; sometimes it will, but the cases are very rare — far 
oftener, if neglected, it will lead to troubles that will shorten life, 
and make miserable what is left. Inflammation of the bladder, and 



INFLAMMATION OF URETHRA. 173 

perineal abscess, stricture, and gleet, are the common consequences 
of uncured claps. 

But the disease, with care, may be cured as certainly as a cold in 
the head, for it is, like that, a catarrhal inflammation of a mucous 
membrane; only it has a greater tendency to spread. Let the per- 
son remain in the house a few days — in bed, if possible, and treat 
himself as for a cold. Take ten grains of blue-pill, and in a few 
hours an ounce of the fluid extract of senna, with a drachm of Epsom 
salts, and use bland, demulcent drinks, flaxseed-tea, gum-water, or 
barley-water, abstaining from stimulants and from an exciting diet. 
Use no injections at all, but, if the ardor urinoz is severe, let the 
penis hang for a considerable time in warm water, which will relieve 
the inflammation. If the chordee is severe, apply cloths wet in ice- 
water till the erection is reduced. In the immediate agony of this 
pain, when it awakes the person from sleep, an effective remedy is to 
bend the penis by force toward the under side. This relieves the 
tension on the inflamed urethra, which is the cause of the pain. 

When the activity of the inflammation is lessened, take the bal- 
sam of copaiba. This may be taken in mixture : 

Balsam of copaiba, 1 ounce. 

Mucilage, . . .1 ounce. 

Camphor-mixture, 4 ounces. 

Take a tablespoonful morning and evening. 

If this mixture is found disagreeable, the copaiba may be taken 
as prepared in capsules by the French apothecaries. 

Should the copaiba alone fail to check the discharge in a few days, 
use cubebs at the same time. Take of the powder of cubebs a drachm, 
in water or milk, three times a day. Powdered alum may be added 
in small quantity with some advantage. 

Should the discharge persist after all inflammation is subdued, 
use an injection composed of — 

Sulphate of copper, 6 grains. 

Rose-water, 12 ounces. 

As it is of great importance that an injection should be applied 
so that it should come in contact with every part of the inflamed 
surface, we here append a few directions for its proper application : 
First take care that the syringe, be it of pewter or of glass (gutta 
percha is the best), works freely and easily with a slight pressure of the 
fingers. From one and a half drachms to two drachms of the liquid 
is the quantity required at once, and, when the instrument is charged 
with this, insert the point carefully to the extent of about half an 
inch within the lips of the urethra, which should be gently pressed 



174 DISEASES OF THE URINARY AND GENITAL ORGANS. 

together so as to prevent the reflux of the fluid, which should be felt 
distending the passage as far down as the membranous portion. 
When the syringe is emptied, withdraw the point, and keep the 
orifice of the urethra pressed together, as above directed, for two 
minutes or more ; then withdraw the pressure, and the liquid will 
flow out, most likely with considerable force, in consequence of the 
elasticity of the canal, which it is advisable to clear by making 
water before using the injection ; and this reminds us of a popular 
notion that mischief may be done by the injection reaching the 
bladder ; but this is an idle fear with the charge which an ordinary 
syringe can convey. An injection should never be so strong as to 
cause much smarting or pain in the passage, only a sense of titilla- 
tion; it is best to begin with it very weak, and gradually increase 
its strength. Swollen testicles and sympathetic buboes are by some 
attributed to the use of astringent injections, but these occur when 
no injections are used. 

GLEET. 

When gonorrhoea is neglected, a confirmed gleet is often the 
result, which is very difficult of cure, the discharge being intermit- 
tent, sometimes profuse, and, at others, but a few drops now and 
then in straining at a costive motion or the like. There is gen- 
erally little or no color in it, but sometimes it becomes yellow, and, 
under the effect of much excitement, green, and even bloody ; it may 
be rendered so, and purulent, by excesses of any kind. The med- 
ical treatment consists in the exhibition of the following medicines : 

Sweet spirits of nitre, 2 drachms. 

Balsam of copaiba, 1 drachm. 

Mucilage of acacia, .1 ounce. 

Camphor-mixture, sufficient to make six ounces ; take a tablespoonful two 
or three times a day. 

If this fails, let the following pills be taken : 

Powder of Spanish flies, 3 grains. 

Ohio turpentine, 1 drachm. 

Mix and divide into twelve pills ; take one three times a day. 

The local treatment consists in the use of bougies and injec- 
tions; the best formula for the latter is bichloride of mercury, 
half a grain ; distilled water, six ounces ; after a time the strength 
may be doubled, but stronger than this it should not be used ; if it 
does not succeed, a solution of ammoniated copper, or sulphate of 
copper, may be tried. Sea-bathing, rest, and tranquillity, a toler- 
ably generous diet, are among the most important remedial meas- 
ures. Gleety discharge sometimes proceeds from a scrofulous or 



STRICTURE, OR RETENTION OF URINE. 175 

relaxed state of the system, and, in this case, tonics should be ad- 
ministered. 

Female gonorrhoea and gleet are not so decidedly affected by the 
specific medicines copaiba or cubebs, as they are in the opposite 
sex ; a free use of diluents, and such lotions as the diacetate of lead, 
to appease the local inflammation, will generally prove successful, 
if persevered in, and accompanied by rest and gentle aperients ; a 
sponge dipped in the lotion should be allowed to remain in the 
vagina, frequently cleansing and changing it. Female children, 
from a very early age up to that of puberty, have sometimes a puru- 
lent discharge from the pudendum, which may be thought gonor- 
rheal by those ignorant of their liability to it. Unpleasant suspi- 
cions, and even accusations may, as they have done, arise out of 
this ; but a surgeon can at once assure the parents that they are un- 
founded. The proper treatment in this case is the administration of 
calomel and rhubarb, combined with a little jalap, and the applica- 
tion of black- wash to the inflamed parts. 

STRICTURE, OR RETENTION OF URINE. 

Symptoms. — Frequent occasion to pass water; dribbling of a 
few drops afterward ; slight pain beneath the root of the penis ; the 
stream of water smaller than usual, forked, twisted, or scattered, 
and requiring efforts to void it. Occasional spasmodic attacks of 
difficulty in passing water; disturbed sleep; disordered health ; de- 
pression of spirits, etc. 

Causes. — Inflammation and irritability of the membrane lining 
the passage. 

Treatment. — A hot bath, with moderate repeated doses of 
opium, will often relax the spasm that sometimes causes retention 
of urine ; if these fail, a small catheter should be tried until, after 
gentle pressure, it will pass through the obstruction. The instru- 
ment should afterward be used every three or four days, a larger 
being gradually employed. The operation of passing the catheter 
should, if it be by any means possible, be confided to the skill of a 
medical man. If this cannot be, the non-medical operator may, per- 
haps, be guided by the following brief directions : 

A catheter should be selected having a calibre of about a com- 
mon writing-quill. It should be carefully inserted into the orifice 
of the penis, which for that purpose should be drawn forward be- 
tween the fore and second fingers of the left hand. The curvature 
of the catheter should be steadily kept looking upward and back- 
ward. The point of the instrument being gently pressed against 



176 DISEASES OF THE URINARY AND GENITAL ORGANS. 

the upper surface of the urinary passage, will, after a while, slip 
into the bladder with a distinct, sudden giving way of resistance. 
Violence is to be carefully avoided, or the instrument will pierce the 
surrounding structures, and thereby cause fatal mischief ivithout 
present relief 

Many old men require the passage of a catheter twice a day. 
They easily learn to perform the operation for themselves. 

If the retention proceed from inflammation of the bladder, it will 
generally yield to the treatment for that disease. 



SPERMATORRHOEA, INVOLUNTARY OR NOCTURNAL EMISSIONS, 
IMPOTENCE. 

An occasional nocturnal emission in a person of otherwise ordi- 
nary health is not a sign of disease. It only indicates the tendency 
of thought in dreams. But where this occurrence is constant, where 
the part cannot come in contact scarcely with the wearer's gar- 
ments, and where the least thought of sexual tendency excites emis- 
sion, the case is different. Here the irritability of the parts is such, 
that a touch, or the excitement of thought, effects what ought to re- 
quire sexual congress. Consequently the system experiences con- 
stant loss, and upon the. losses follow greater weakness, greater 
irritability, matters growing worse and worse, till finally there is 
complete want of nervous power, and incapability of erection ; all 
running on from the impotence of one organ to impotence in all, and 
final insanity. 

The cause of the excessive irritability in which all this trouble 
begins is ninety-nine times in a hundred the habit of masturbation, 
or self-abuse. Treatment must begin with the absolute discontinu- 
ance of this habit, and the adoption of a regimen of life adapted to 
give tone to the system. Bathing in cold water, life in the open air, 
a light diet, no stimulating drinks or food, no romances to read, and 
the smallest amount of sleep taken that the system can bear. 

Take at the same time the following : 

Tincture of the chloride of iron, 1 ounce. 

Tincture of ergot, .1 ounce. 

Tincture of the vomica-nut, \ ounce. 

Take ten to twenty drops in water three times a day. 



DISEASES OF THE HEART AND ARTERIES. 



In a structure so complex, and formed of such different tissues as 
the heart is, one might expect that it would be subject to many dis- 
eases of both a general and a partial character; and, accordingly, 
we find there are few persons who have not had to complain of 
symptoms which were indicative of heart affection of some kind, al- 
though few, perhaps, really have what may be properly called heart- 
disease. Strong emotions of the mind, derangements of the liver or 
stomach, will often cause flutterings and palpitations, an increase or 
decrease of arterial action, and other symptoms, which would seem 
to indicate that there was something very wrong with the great or- 
gan and centre of circulation; but these symptoms, in the great 
majority of cases, are merely sympathetic; and very commonly, 
when a person is said to die of " a broken heart," there is no organic 
disease to justify the popular verdict. 

Diseases of the heart may be arranged in two classes ; those that 
are strictly nervous, in which the function of the organ only is dis- 
ordered ; and those that are organic, in which there is a change of 
some part of the substance of the heart. 

The common organic diseases are inflammation of the pericardium 
or envelope of the heart, pericarditis ; inflammation of the lining of 
the heart, endocarditis ; valvular disease, a consequence of the last- 
named; hypertrophy, or enlargement; and fatty degeneration, 
sometimes inducing rupture of the organ. All these diseases have 
so nearly the same history, symptoms, and management, and are so 
little subject to medical treatment, fhat it is scarcely worth while to 
distinguish between them. Both pericarditis and endocarditis are 
inflammations apt to occur in cases where other inflammations occur, 
but they have a peculiar relation to rheumatism. The poison in the 
blood that affects the joints in rheumatism, affects the parts of the 



178 DISEASES OF THE HEART AND ARTERIES. 

heart covered by these membranes, and they become inflamed. In 
pericarditis this leads to water on the heart, and great embarrass- 
ment of the heart's action. In endocarditis it leads to valvular dis- 
ease. The valves of the heart become contracted, and insufficient 
for their purpose, and, because of the defective state of the valves, 
the heart, to carry on the circulation, works harder. This excessive 
action induces hypertrophy. 

In all cases the only thing to be done for organic disease of the 
heart, that is within reach of domestic management, is to save the or- 
gan by rest. In excitement, in exertion, in exposure, in the use of stim- 
ulants, there is constant aggravation of the trouble by the enforced 
activity of the heart. A quiet life, that keeps the pulse equable and 
calm, and sedatives, if necessary, are the remedies. The best seda- 
tive, and one that may be used through years, is the infusion or the 
syrup of wild-cherry bark. 

In the class of nervous disorders of the heart are palpitation, 
angina pectoris, and syncope. 

Palpitation of the heart has been experienced by most persons 
who have run themselves out of breath, or, by any violent exertion, 
causing a great increase of action in the respiratory and circulatory 
organs. In a healthy and proper state, we are not generally sensi- 
ble of the regular beat, beat of the pulse, which goes on night and 
day, whether we sleep or wake, and tells that the great organ of 
vitality is duly performing its office ; but when, from any cause, 
these beats become unusually frequent and forcible, we both feel and 
hear them, in a very troublesome and distressing manner ; and es- 
pecially is this the case when the bodily strength has been reduced, 
and the nervous sensibility increased by illness ; then we seem to 
feel within us the swing of a great pendulum, and the throb! 
throb ! vibrates through the chambers of the brain, and appears to 
call forth echoes from every cavity and passage of our internal 
structure, in a manner that is perfectly agonizing. Sometimes the 
pulsations are loud, and clear, and regular, at others they are faint 
and intermittent ; now a distant throb, or several, and then a tremu- 
lous flutter, or a quick beat, like the wings of a confined bird, flap- 
ping against the bars of its prison. When there is violent throbbing 
of the heart, which may be felt by a hand pressed upon the chest, 
while the patient is himself unconscious of it, there is reason to ap- 
prehend organic disease ; but, when there is such acute consciousness 
as we have described, there is generally only functional or nervous 
derangement, without any structural change. A disordered stomach 
may be the cause, although there may be no other symptoms of this. 
Slight irregularity in the mode of living has produced palpitation of 



DISEASES OF THE HEART AND ARTERIES. 179 

the heart, and that, too, in an otherwise healthy person. In some, 
almost any strong nervous stimulant will produce it. In some per- 
sons it always comes on after a cup of tea, and is never troublesome 
when this beverage is not taken. Palpitation is not always, nor in- 
deed commonly, symptomatic of heart-disease ; and need therefore 
cause no unnecessary alarm, although its frequent recurrence should 
set the patient inquiring as to what is the real cause. Young 
women with whom there is derangement of the menstrual functions, 
in whom the blood is watery and poor, wanting the red corpuscles ; 
the listless, the pallid, the hysterical, in these we meet with palpita- 
tion in its most aggravated forms ; as also in the indolent, the sus- 
ceptible, and the delicate. In these cases the only treatment likely 
to be of service must be directed toward removing the predisposing 
and exciting causes, and establishing a more healthful nervous con- 
dition — gentle exercise, tonics, change of air and scene ; an endeavor 
to occupy the mind in some useful and moral pursuit ; a well-regu- 
lated and generally frugal, although sufficiently nourishing diet ; and 
a strict avoidance of all that can excite or stimulate either mind or 
body. By this means palpitations, not connected with organic dis- 
ease, may generally be relieved. If the patient is of a full habit, and 
has a tolerably strong pulse, bleeding or cupping may, perhaps, be 
resorted to with advantage ; but this should be cautiously done. 
In such, too, a course of gentle purgatives may be necessary ; they 
should not be salines, but of a cordial nature, something like this : 

Pill of aloes and myrrh, and comp. galbanum pill, of each •£ a drachm. 
Divide into twelve pills, and take one at bedtime. 

Compound infusion of senna and decoction of aloes, of each 3 ounces. 

Spirits of sal-volatile, 1 drachm. 

Compound tincture of cardamoms, . . . . .2 drachms. 

Tartrate of potash, •£ ounce. 

Mix, and take two tablespoonfuls occasionally. 

Angina pectoris is a disease commonly connected with ossifica- 
tion, or other morbid affections of the heart ; it is characterized by 
a sudden and most violent pain accross the chest, which extends 
down the arms, and seems to threaten immediate dissolution. It 
sometimes comes on during rest, but most usually after violent ex- 
ertion ; the paroxysm does not commonly last long, but it has been 
known to continue for an hour- or more. It is not much under the 
control of medicines, but may be sometimes greatly relieved by rub- 
bing over the seat of pain, warm applications, and the administration 
of antispasmodic medicines, as camphor or chloroform. An anodyne 
combined with ammonia has sometimes been found very effectual in 
relieving the spasm ; the following is a good formula : 



180 DISEASES OF THE HEART AND ARTERIES. 

Chloroform, 2 drachms. 

Aromatic spirit of ammonia, 2 drachms. 

Compound spirit of ether, 4 drachms. 

Paregoric, 4 drachms. 

Mucilage, 4 drachms. 

Mix. Take a teaspoonful, and repeat in half an hour if necessary. 

» 

If the paroxysm is very violent, a little hot brandy and water 
may also be taken. In the intervals between the attacks, the system 
should be strengthened as much as possible, and care taken 
to keep the patient quiet ; excitement, either physical or mental, is 
likely at any time to bring on the pain. An issue over the seat of 
the disease is sometimes of great service, and an application of sul- 
phate of zinc has effected a cure. 

Syncope is a sudden cessation of the heart's action through dis- 
turbance of the nervous influence, etc. Generally, it is momentary, 
but sometimes is continuous, and bears some resemblance to apoplexy. 
In the latter case it is a symptom of fatty degeneration of the heart. 
For the common form the remedies are the same as for angina pec- 
toris — stimulants and nervines. 



ANEUKISM, 

Associated with disease of the heart, is this disease of the arteries. 
Aneurisms may be internal or external : in the former case being 
so situated in the cavities of the body, as in the abdomen, chest, or 
cranium, as to render the nature of the disease often very doubtful ; 
in the latter they are so placed in the limbs that access may be easily 
had to them. The whole arterial system is liable to aneurisms ; but 
they occur much more frequently internally than externally, and 
oftener, according to some authorities, in those main trunks near the 
heart than elsewhere : they usually occur in persons of advanced 
age, such being most liable to chalky depositions of the coats of the 
arteries, which are among their predisposing causes, with which may 
also be named violent contusions, abuse of spirituous liquors, fre- 
quent use of mercurials, fits of anger, extension of the limbs, strain- 
ing, and violent exertion of any kind ; gunshot, and other wounds, 
also frequently cause aneurisms. Few persons long addicted to 
intemperate habits escape this disease. 

The symptoms of an aneurism are in the early stage a small 
tumor, pulsating very strongly, more or less evident to the sight 
and touch according to the depth at which it is seated. Sometimes 
its presence is only known by the rapid pulsation, and pain, and ten- 
derness of the part : sometimes, only as it interferes with the func- 



ANEURISM. 181 

tions of some important organs, producing impeded respiration, 
cough, and other distressing symptoms, and ending in death; for 
which, without a post-mortem examination, the physician can assign 
no adequate cause. For the internal form of the disease no remedial 
measures can be advised, beyond those recommended for organic 
diseases of the heart. 

Treatment of External Aneurisms. — This must also depend 
very much on circumstances. They are often formed on the principal 
arterial trunks of the upper and lower extremities, or of the neck, as in 
the carotid : the pulsating tumor, at first filled with fluid blood, 
which can be pressed out if the finger is passed gently along it, 
gradually becomes firmer and harder, assuming the character of a 
solid swelling, retarding the circulation by pressure on the sur- 
rounding parts, and causing muscular spasms, cramps, and sudden 
twitchings. If situated near the joint of a limb, the motion thereof 
becomes impeded, and inflamed swelling of the whole part often 
ensues ; the cuticle covering the aneurism assumes the appearance 
of a blistered surface; finally, the sac opens, blood issues forth, 
which continues to flow from time to time, and the patient dies from 
weakness occasioned by loss of blood, or by the setting in of gan- 
grene, which spreads up the limb, should it not be removed, 
and so causes death. Pressure upon the artery, so as to stop the 
flow of blood into the sac, has been recommended of late; but it 
causes greater pain than can be generally endured, and does not ap- 
pear to have answered in the majority of cases in which it has been 
tried. A surgical operation appears to give the best chance of a 
cure ; and this, which consists in dividing and tying the artery on 
which the aneurismal tumor is situated, can be of course done only 
by a surgeon. 

Xo external irritant liniment or friction must be applied in aneu- 
rism ; nor fomentations and other hot applications. When the bleed- 
ing has commenced, the strength must be sustained by good, 
nourishing diet ; but, until it has, it is best to keep the system low : 
active exertion must be avoided, both mental and physical, and also 
pressure upon the part affected. In varicose aneurism^ often caused 
by a wound in the brachial artery, there is usually a tumor situated 
at the bend of the arm, which generally proceeds to about the size 
of a walnut or pigeon's-egg, and then remains stationary, causing 
some inconvenience, but resulting in no very serious consequences ; 
the limb is, perhaps, weakened, and there is a peculiar and unpleas- 
ant vibrating thrill felt, or communicated to the ear. 



DISEASES OF THE SKIN AND ITS APPEND- 

AGES. 



RASHES AND ERUPTIONS. 

Of all common rashes, and those eruptions on the whole or part 
of the general surface of the body, which it is not necessary to treat 
of distinctly in a work like the present, the common exciting causes 
are sudden chills from drinking cold water, or eating cold vegeta- 
bles ; catching cold by wet feet ; excess or imprudence in diet ; 
constipation of the bowels, and other causes of derangement of the 
stomach, and of impurity in the blood. 

The common rashes which appear in blushing patches, gradually 
deepening to a rose-color, often alternately fading and reviving, and 
appearing chiefly on the cheeks, neck, or arms, are troublesome, but 
of no other importance. They require attention to the state of the 
digestive organs, and the regulation of the bowels by exercise and 
Scotch oatmeal, or the occasional use of an aperient. 

Those rashes which are attended with small pimples, and a pain- 
ful itching, are still more troublesome than the last, and will require 
more careful attention to the correction of constitutional disorder, 
by the use of alteratives and aperients, and a proper diet and 
regimen. The body must be kept cool, and the bowels open, the 
diet consisting chiefly of wholesome vegetables, and ripe fruits, with 
fresh animal food. The use of a drachm of sarsaparilla-powder in 
water, twice a day, is an excellent plan, the tepid bath at ninety- 
seven degrees being employed thrice a week. The extract of dan- 
delion is sometimes extremely beneficial. The following mixture 
also is useful in these and all other cutaneous eruptions : 

Take of ipecacuanha- wine, 4 drachms. ' 

Flowers of sulphur, . . . . . .2 drachms. 

Tincture of cardamoms, 1 ounce. 

Mix. One teaspoonful to be taken thrice a day, in a wineglassful of water. 



RASHES AND ERUPTIONS. 183 

In obstinate cases, sea-air and sea-bathing, or the internal use of 
Congress-water, are very advisable; and the compound decoction 
of sarsaparilla, with a couple of drachms of antimonial wine to each 
pint, is sometimes useful. 

The nettle-rash {urticaria), an eruption of the skin, similar to 
that produced by the sting of nettles, consisting of solid eminences, 
or wheals of an oblong shape, is characterized by a burning and 
tingling sensation with great irritation, heat, and itching. It is 
generally thrown out by some particular kind of food which disagrees 
with the system, such as crabs, or other shell-fish, or mackerel; cer- 
tain vegetables are likely to produce it, such as mushrooms, cucum- 
bers, bitter-almonds, or strawberries. Copaiba, cubebs, valerian, or 
the fumes of turpentine inhaled during a house-painting, are also 
likely to occasion nettle-rash. 

Of this disease there are two varieties, distinguished as the acute 
and chronic : the first runs a short and rapid course, and is attended 
by febrile symptoms. An emetic should be first administered, if the 
eruption is caused by any thing recently taken into the stomach ; it 
should be followed by a saline aperient — senna mixture, with salts, 
is perhaps best, and this repeated until the bowels are freely moved ; 
if the febrile symptoms do not subside, a mixture composed of sweet 
spirits of nitre, two drachms, liquor of acetate of ammonia, one ounce, 
and camphor-mixture, five ounces, should be given, two tablespoon- 
fuls every four hours ; a small dose of calomel may also be required. 
In the chronic form, a simple diet, active exercise, an avoidance of 
any articles of diet likely to excite the eruption ; keeping the bowels 
regular, by gentle aperients, combined with antacids ; a five-grain 
rhubarb-pill an hour before dinner, or a small. piece of the root 
chewed, is a good remedial means ; the tepid bath should be occa- 
sionally used, or sponging, to keep the skin in a healthy state ; to 
allay the irritations, dust starch-powder over the eruptions, or use a 
lotion made of rose or elder-flower water, in half a pint of which have 
been dissolved one drachm of carbonate of ammonia and half a 
drachm of sugar of lead. 

Erythema is a morbid redness of the skin, sometimes called in- 
flammatory blush, and considered as a milder form of erysipelas ; 
from which, however, it differs in not being contagious, and yield- 
ing more easily to medical treatment. Sometimes the surfaces are 
smooth and shining, and like small ' pimples or tumors, appearing 
generally on the face, breast, or arms ; again they appear as red 
shining patches on the front of the legs, and sometimes on the arms, 
assuming a purplish tint after some days, like a bruise. This form 
appears to be almost peculiar to young women. Then there is the 
13 



184: DISEASES OF THE SKIN AND ITS APPENDAGES. 

red gum or tooth-rash of children, and the redness occasioned by 
irritating discharges, such as of the fauces in diarrhoea, or of tears 
when of an acrid character, or the chafing between the folds of the skin 
of children, which results from want of proper care in frequent wash- 
ing and drying the parts. Sometimes after dancing or any violent 
exercise, drinking cold water when in a heated state, or eating too 
largely of fruit or other substances, red spots and patches will ap- 
pear on the back, shoulders, and face, more particularly of young 
persons ; and all these are different varieties of erythema, one of 
whose peculiar characteristics is that the redness disappears on press- 
ure of the inflamed part, but shows itself again in a second or two 
after the finger is removed. 

The proper treatment for children is bathing the part affected 
freely with hot water, and then drying thoroughly, and applying 
powdered starch or violet powder ; give, at bedtime, two or three 
grains of the gray powder (mercury and chalk), with a senna 
draught, or a dose of castor-oil in the morning ; following it up with 
small doses of quinine, according to the age of the child. Should 
the inflammation not yield to this treatment, after a few days, use 
the sugar-of-lead lotions recommended for erysipelas, and still pro- 
ceed with the quinine, to which rapidly-spreading erythema scarcely 
ever fails to yield. This course of treatment may be applied, in most 
of the common forms of the disease, to patients of all ages ; but there 
are one or two exceptional forms to which it is not applicable, such 
as the form already alluded to as chiefly attacking young women, 
and of these such as are of a delicate constitution ; it is especially 
likely to come on after scarlet fever or measles. As this is attend- 
ant on a debilitated state of the system, it requires nourishing food 
and strengthening medicine. For its removal some preparation of 
iron, with infusion of quassia, and an aromatic tincture, or cinnamon- 
water, will make a good mixture ; or take the following : 

Sulphate of quinine, 12 grains. 

Diluted sulphuric acid, 1 drachm. 

Compound tincture of cardamoms, . . . ' . -£ ounce. 

Infusion of roses, 12 ounces. 

Dose, two tablespoonfuls two or three times a day ; change of air is also desirable. 

The " fever-sores " {herpes) that appear on the lip, in consequence 
of any little disorder of the system by cold, scarcely need treatment. 
Any simple aperient, a dose of salts, castor-oil, or magnesia, that 
carries off the cold, cures them. IsTo irritating applications should 
be made to " dry them up." Another development of the same 
eruption is the breaking-out about the mouth in children called 
tetter. There are itching and swelling of the part, and a number of 



RASHES AND ERUPTIONS. 185 

vesicles appear that run together, and form an irregularly-shaped 
blister. When the fluid under the blister escapes, a scab forms, and 
healthy skin grows beneath. 

Similar in nature are ringworm [herpes circinatus), and shingles 
(cingulum, or herpes zoster). 

Ringworm appears in small circular patches, in which the ves- 
icles arise only around the circumference. Ringworm of the scalp, 
or scalled head, appears in distinct and even distant patches of an 
irregularly-circular form upon the scalp, forehead, and neck. 

The latter form is called pustular. It is the most obstinate and 
troublesome. In it the scaly pustules are clustered together in 
elevated patches ; a roughness and discoloration of the skin gen- 
erally precede the appearance of the pustules, which are of a brown 
tint in one variety, of a straw-color in another ; in the latter case 
the scales or crusts after a while fall off, leaving a number of small 
cap-shaped ulcers, clustered together like honey-comb ; these spread 
very quickly, sometimes involve the whole scalp, and even extend 
to the neck and forehead. 

Ringworm has its seat in the roots of the hair, and is believed to 
be attended by the growth of parasitic fungi ; its predisposing 
causes are any derangement of the general health from ill or under- 
feeding, breathing impure air, drinking bad water, uncleanly habits, 
scrofula. Its immediate or exciting cause is generally contact with 
those affected with it, or using combs or hair-brushes which they 
have used. 

Subdue first the irritation by such soothing means as warm poul- 
tices, etc., and then use an ointment composed of one drachm of Sul- 
phate of zinc to one ounce of simple cerate, using also a sulphate-of- 
zinc lotion. The head, from which the hair has been previously re- 
moved, by shaving or close cutting, should be washed with soap once 
a day, and, after being dried, anointed with pomatum, so as to keep 
the scalp moist with oleaginous matters. Another good application 
is, a solution of one drachm of nitrate of silver in half an ounce of 
diluted nitric acid. The diseased circles, after the scalp has been 
shaved, to be pencilled over with the solution, and in ten or fifteen 
minutes afterward the parts should be well sponged, first with tepid 
water, and then covered with pledgets of lint dipped in cold water, 
and the evaporation diminished by covering the wet linen with oiled 
silk. A lotion composed of a drachm of carbolic acid and an ounce 
of water is more effective perhaps than any other application. 

Indeed, almost any astringent application will be found service- 
able in this disease. Pyroligneous acid is used with great advantage, 
and black ink, which contains galls and sulphate of iron. Tar and 



186 DISEASES OF THE SKIN AND ITS APPENDAGES. 

creosote are both recommended, and may be serviceable ; but they 
are disagreeable applications, the former especially so, and certainly 
not better than many others which have not this objection ; we 
should recommend their being used only as a last resource when the 
disease is very obstinate, as is sometimes the case. Rubbing the 
raised parts lightly with sulphate of copper, previously moistened, 
or washing them with a strong solution of nitrate of silver, or con- 
centrated acetic acid, are the local applications of much value. For 
general or constitutional treatment we would recommend a tolerably 
generous diet with quinine or iron tonics, after the system has been 
cleared by a course of mild aperients and alteratives, such as rhu- 
barb and gray powder, say three doses, according to age, one every 
other night, using any other means that may suggest themselves to 
strengthen and invigorate the patient. 

The vesicular form of ringworm (that most commonly called 
ringworm) is the simplest and most amenable to treatment ; some- 
times it disappears after careful washing and poulticing, with, per- 
haps, a few applications of the carbolic acid lotion or the local appli- 
cation of castor-oil. But the pustular form treated above (and com- 
monly designated scalled head) is far more troublesome and intrac- 
table, spreading often very rapidly, and running into ulcerous sores, 
and sometimes reappearing when it is thought that a cure has been 
effected. Nothing but the greatest care and attention will then 
eradicate it. Any child afflicted with this disease should be sepa- 
rated from other children, on account of its contagious nature ; wear- 
ing each other's caps and bonnets will be likely to spread it through 
a whole school. 

Shingles is an eruption which consists of vesicles in distinct clus- 
ters, upon inflamed bases, that extend a little beyond the margin of 
each cluster. It is generally preceded by such constitutional symp- 
toms as loss of appetite, headache, cold chills, sickness, and acceler- 
ated pulse. Sometimes there are heat and pricking in the skin, and a 
Bensation as though hot needles were thrust into it ; or there may 
be a deep-seated pain in the chest. At times, however, the patient 
has no warning of this kind, and he is first made aware of the affec- 
tion by the appearance of red patches, with small elevations, clustered 
together ; these gradually enlarge, and become clear and glassy, 
being filled with a colorless lymph, which first turns milky, and then 
concretes into scabs. As the crusts fall off, and the eruption disap- 
pears at one part, it frequently shows itself in the immediate vicinity, 
and so gradually creeps all over the skin ; sometimes there are a free 
discharge and ulceration. In some cases the clusters of eruption 
begin at the loins, and extend downward to the thighs and legs ; 



RASHES AND ERUPTIONS. 187 

very commonly they form a sort of band round the waist, and hence, 
probably, the name given to the disease. From the twelfth to the 
fourteenth day is the time at which the scabs, if a cluster, may be 
expected to fall off, leaving the skin beneath red and tender, with 
little indented rings, where the vesicles have been. Generally the 
disease runs its course in about three weeks ; it is not contagious, 
and may attack the same person more than once. Young persons 
between twelve and twenty-five years of age appear to be most sub- 
ject to this disease, which, however, sometimes attacks aged people. 
Summer and autumn are the seasons when it most prevails; the 
cause of it is not very clear ; probably it may arise from sudden 
changes of temperature, and chills taken when in a heated state. 
Give aperients to keep the bowels gently open, with a light and 
nutritious diet; effervescing draughts, made with bicarbonate of 
potash, instead of soda ; if, as is sometimes the case, there is much 
pain, take Dover's powder at bedtime, from five to ten grains, ac- 
cording to age ; bathe the eruptions with Goulard water, and dress 
them, when discharging, with zinc-ointment, spread upon lint ; old 
persons will require tonics and change of air, but the young gener- 
ally get over it without this ; although, for all, a little strengthening 
medicine is desirable. 

Eczema is an eruption of the most obstinate character. It appears 
in patches of minute vesicles, or watery pimples, in great numbers, 
close together. Sometimes the vesicles are so closely collected as to 
form one large inflamed surface. It favors those parts of the sur- 
face on which hair grows, and may run over the whole scalp. The 
vesicles dry up and form thin crusts and scales, or they burst and a 
thin watery fluid exudes. The eruption may be situated upon limited 
portions of the body, or in many places at the same time. The dis- 
ease may be acute or chronic. Though its manifestation is strictly 
on the skin, it is a true constitutional disease. According to the 
severity of the case, the constitutional affection must be more or less 
actively treated. Without this, local or external applications will 
be of but little use. In the acute form the simple warm-water dress- 
ing of lint and oil silk, or local warm bath. Lotions of Goulard 
water, or, if this fail, solution of nitrate of silver of the strength of 
about four grains to the ounce of water. The itching may be relieved 
by the addition of laudanum to the lotion. 

Chronic eczema, like most chronic skin-diseases, is a very obsti- 
nate malady, and will require variation in treatment. Any one or 
more of the following will be found useful in some cases, but not in 
others ; therefore, if after a few days' trial benefit is not received, a 
change should be made : Corrosive-sublimate lotion consisting of a 



188 DISEASES OF THE SKIN AND ITS APPENDAGES. 

quarter of a grain to the ounce of water ; white-precipitate ointment ; 
red-precipitate ointment ; tar-ointment ; sulphur-ointment ; mercuri- 
al ointment; creosote lotion, alkaline lotions. Common chimney- 
soot sprinkled over the inflamed surface is a dirty remedy, but one 
that has been recommended ; it has, at all events, the merit of being 
always at hand. 

Perhaps the most effective treatment is, to dress with a mixture 
of equal parts of powdered starch and glycerine, and, when there is 
a smooth, shining surface, apply oil of juniper. An effective plan 
of treatment is, to wash the part with a lotion of 

Carbolic acid, 2 drachms, 

Water, 2 ounces, 

and to give at the same time a full dose of soda every day. 

Ecthyma is a pustular eruption that occurs principally in the 
scrofulous, but may occur where the system is, from any cause, 
temporarily deranged. There is first a vesicle that bursts, and 
leaves a cup-shaped sore with well-defined edges. 

Improve the state of the system with alteratives and tonics, and 
apply to the sores a weak solution of the nitrate of silver. 

The common pimples that appear on the skin of persons whose 
stomachs are habitually deranged and overloaded, are the result of an 
irritation in the sebaceous glands. These glands secrete an unctu- 
ous matter, that, poured out in proper quantities, keeps the skin soft. 
They are situated in the skin, and are most numerous about the face 
and nose. Sometimes the orifices of these glands become black, 
and then they give to the face a very unsightly appearance; on 
squeezing the skin around them, the fatty matter oozes out in the 
shape of a small worm with a black head, and this it is popularly 
thought to be ; but, although the matter itself is really not a crea- 
ture, it is the habitat of a minute parasitic worm, which varies in 
size from l-64th to l-135th of an inch. 

There are usually two, but often more, in the sebaceous contents 
of each follicle. They exist in the most healthy skins, although they 
do not cause any irritation and annoyance, unless they become 
unduly numerous. The irritation that causes the pimple to rise is a 
consequence of their increase. To prevent such a result as this, and 
the presentation of the unsightly " black heads," the face should be 
frequently washed in warm water, and well rubbed with a towel. 
Sometimes their appearance is attended with disorder of the stomach, 
which requires attention. Ladies hide these black heads with lily 
white. The penalty for this is that the glands themselves cease to 



DANDRUFF. 189 

be effective in the performance of their office, and the skin "becomes 
harsh, dry, and cracked. 

The prepared chalk, so commonly used for the face in these cases, 
is carbonate of lime, and the human skin cannot be whitewashed 
with permanent advantage. It is a delusive remedy to prevent the 
vulgarity of a greasy skin by such means. The safer plan to make 
such faces presentable for given occasions is to neutralize the excess 
of oily matter that may be present, by washing the face with 
water to which a very little aqua ammonia is added, and then dust- 
ing with finely-powdered starch. This plan followed discreetly will 
be quite effective, and will never do harm. 

The pearl powder is made of bismuth and French chalk, and is 
sometimes apt to change color on the face, especially if onions are 
eaten. The favorite wash known as Rowland's kalydor is made as 
follows : 

Blanched bitter almonds, 1 ounce. 

Rose-water, 16 ounces. 

Rub the almonds down with the water, strain, and add eight grains of cor- 
rosive sublimate. 

The harmless wash known as milk of roses is made as follows : • 

Bitter almonds, 6 drachms. 

Sweet almonds, 12 drachms. 

Blanch and beat up in a mortar, with 1 drachm of Castile-soap. Add gradu- 
ally: 

Spermaceti, 15 grains. 

"White wax, 30 grains. 

Almond-oil, 1 drachm. 

Previously melted together. 

When these are thoroughly mixed, add six drops of otto of roses, 
in six ounces of rose water, and after, fourteen ounces of distilled 
water. 

It has been well said that the best cosmetic is a good temper; 
this, with cleanliness and obedience to the laws of nature and of 
health, will make a face more pleasant to look upon than all the ar- 
tificial aids of paint, pomatum, kalydors, and lotions ; better to see 
a few freckles and personal blemishes, than to mark the result of 
efforts to hide natural defects, which, after all, can be but partially 
successful, and which, however well intentioned, impress with a 
painful sense of an attempted imposition. 

DANDRUFF {Pityriasis), 

A chronic, squamous disease, in which there is a copious production 
of minute white scales that fall. This, like many other affections of 



190 DISEASES OF THE SKIN AND ITS APPENDAGES. 

the skin, is rather troublesome and annoying than dangerous ; it fre- 
quently occurs in children, and most commonly in the scalp, but 
sometimes, with persons of fair complexion, in the face also. The 
scales should at all times be removed by brushing and washing 
gently, so as not to irritate the skin, and the parts rubbed with com- 
mon pomatum, or an ointment composed of red precipitate ten grains 
to one ounce of lard. Adalts may use an alkaline wash like that 
recommended by Erasmus Wilson, which is: two ounces of solu- 
tion of caustic potash, to eight ounces of rain or rose water. 
A lotion of pecular value in this disease is the following : 

Sulphuret of potash, ....... 2 drachms. 

"Water, 1 pint. 

Dissolve. Apply with a sponge or brush. 

It is scarcely possible to entirely overcome this disease without 
strict attention to keeping the stomach in order. 

MALIGNANT PUSTULE. 

This dangerous sore is the result of the contact of poisonous 
matter from diseased cattle. It may occur in those who labor 
among cattle, from direct contact of the hands conveying the poi- 
son to abraded spots on the face, or it may occur in those who are 
never near cattle, the poison in these cases being probably conveyed 
by flies or other winged insects. The poison excites a peculiar in- 
flammation at the point of inoculation, and from this sore the system 
is contaminated, and death may result in from five to nine days. 

The first appearance is a spot like a flea-bite, scarcely elevated 
above the skin, bluish in color, and itching excessively. From this 
a small vesicle rises, apt to be torn very early by the scratching, 
and leaving a scab on a red base. The scab is yellow, becoming 
brown and black, generally round and thin at the edges. Around 
the central vesicle or scab a circle of smaller vesicles forms — some- 
times only a single circle, sometimes two or three concentric circles. 
The heat is increased locally sometimes to such degree as to give a 
burning sensation. Disturbance of the system comes on in about 
forty-eight hours ; first, general uneasiness, coldness, depression, and 
then reaction, with fever. Sometimes there are internal haemor- 
rhages. 

The treatment must at first be strictly local. Cauterization of 
the sore, with a view to destroying its virulence, is the earliest in- 
dication. Cut the sore open by a crucial incision, apply corrosive 
sublimate, or Vienna paste, freely, and cover with a plaster till the 
caustic substance shall have destroyed the deeper tissue of the pus- 



BOILS. 191 

tule. Lisfranc, in Paris, used the hot iron for the same purpose. 
Acids, the nitric or sulphuric, may be used, but are less certain. In 
countries where this disease is common, the corrosive sublimate is 
generally used. 

Should general symptoms appear, give sulphite of soda freely, 
and sustain with brandy, ammonia, quinine, and beef-tea. 

BOILS. 

The seat of the boil is the true skin and the subjacent cellular 
membrane. A small, angry-looking spot on the outer skin first ap- 
pears ; this gradually enlarges into a swelling with a whitish conical 
centre, surrounded by a hard inflamed base ; sooner or later this is 
sure to suppurate and discharge pus and blood, and a fibrous mass 
called a core; until this latter is ejected the abscess will not heal; 
it often lies deep, and causes great pain before coming away. Warm- 
water bathing, and poulticing with linseed-meal, is the proper treat- 
ment at first ; resin ointment, or Venice turpentine, or some other 
drawing application of an irritating nature, is often applied, but it 
causes unnecessary pain, and effects no object that the poultice 
would not. As soon as the prominent part of the swelling becomes 
soft, a cut should be made with a knife or lancet through the skin 
beneath which the core lies ; this permits the escape of the confined 
matter, and relieves the pain. The poultices should be continued 
until the core is drawn out, soon after which the healing process 
will commence; this may be facilitated by a dressing of simple 
cerate. 

Boils and carbuncles have recently been successfully treated with 
the aqueous extract of opium, of which a thick solution has been 
painted on any suspicious spot ; this forms a coating which must be 
renewed three or four times a day ; twenty-four hours' application is 
said to be generally sufficient to arrest the spread of the inflamma- 
tion. A plaster composed of equal parts of soap, opium, and mer- 
cury, spread on thick leather, is then placed on the spot, having a 
hole in the centre for the escape of any matter; if painful, a poultice 
must be applied. If, in spite of this treatment, the boil will have its 
course, strong nitric acid is the best application, using it freely 
two or three times, taking care to remove the slough before each 
application, supporting the margin with plaster and poulticing 
freely. The beneficial effects of the opium depend upon the 
soothing influence which it exerts upon the capillaries, small ar- 
teries, and nerves ; its immediate effect is to lessen the throbbing, 
heat, and redness. The use of the plaster is to give support to the 
inflamed vessels, and to protect the surface from the atmosphere. 



192 DISEASES OF THE SKIN AND ITS APPENDAGES. 

Boils often follow each other in rapid succession ; they are very- 
painful and troublesome, "but not in themselves dangerous; they 
seldom run into ulcerations and deep-seated, sloughing sores, unless 
neglected ; persons who are obliged to go about their daily avoca- 
tions with them will do well to apply, during the day, a piece of lint 
saturated with olive-oil, and kept on with strapping. For internal 
treatment, those of a full habit should take three or four grains of 
blue-pill two or three times a week; with a senna-draught each 
morning after; they should also be abstemious in their diet, and 
avoid stimulants, particularly malt liquors. Delicate persons should 
take a compound rhubarb-pill every alternate night, or a draught 
composed of rhubarb and magnesia, ten grains of each in cinnamon- 
water ; these should have generous diet. Decoction of sarsaparilla, 
half a tumblerful twice a day, and tepid baths, may be of service 
to such. 

STYE. 

This is an inflammatory tumor or boil in the eyelid. Delicate 
and unhealthy children are much subject to the affection, but some- 
times adults, and even those in robust health, are liable to it. At 
first, there are a little irritation and itching in the upper or lower lid 
of the eye, but more frequently in the former ; then there are redness 
and swelling, and a small boil is developed among the roots of the 
eyelashes ; after two or three days this bursts, and matter escapes ; 
a scab forms, which soon drops off, and probably in a few days there 
is no symptom remaining to mark the spot. 

Treatment. — Commence by fomenting the eyelids, night and 
morning, with warm water, or decoction of poppies, but do not keep 
any application on for more than half an hour at a time ; continue 
with this until the matter is formed and discharged ; then, when the 
scab is formed, smear the margin of the lids, night and morning, with 
a little dilute citron-ointment, taking care that it does not go into 
the eye ; this may be continued for a week or so, giving at the same 
time two grains of gray powder, with about five grains of rhubarb, 
every other night. Persons who are subject to styes should bathe 
their eyelids with a weak solution of salt in water every night and 
morning. A very pleasant form of poultice for the eye is the " alum- 
curd," made by throwing a piece of alum in a cup of boiling milk. 
Apply the coagulated portion on a cloth. 

CARBUNCLE. 

The carbuncle differs from the boil in having no central core, and 
in terminating by gangrene under the skin, instead of suppuration. 
It is usually situated on the back of the neck, or the shoulders, in 



CARBUNCLE. 193 

the interval between them, or -the loins ; a very common situation, 
for it is immediately below the occiput, on the very top of the neck 
where the integument is thickest. The causes of carbuncle are es- 
sentially similar to those of boils ; external irritation of some kind is 
generally the immediate cause ; although there must also be a pre- 
disposition to carbuncular inflammation, arising from a particular 
state and condition of the system, generally an excess of fibrin, or 
inflammatory matter, in the blood. 

The first symptom of the disease is pain, followed by a hard, red 
swelling ; very soon the surface of the tumor assumes a livid tint, 
and a soft, spongy feel ; small ulcers form on the skin, and, from their 
numerous orifices, which give the surface a sieve-like appearance, 
flows out a thin, pasty discharge, which is characteristic of the dis- 
ease. These openings quickly break into one, and then the discharge 
thickens as the dead cellular tissue begins to escape ; to enable this 
to do so freely, an incision down to the very base of the tumor is 
made, and then crossed by another ; the haemorrhage attendent on 
this is commonly very considerable, as well as beneficial, in reducing 
the inflammation. Such is the mode of treatment usually adopted 
in carbuncle ; warm bread or linseed-meal poultices are applied, both 
before and after the cutting ; and, if the bleeding is excessive, port 
wine or decoction of oak-bark, with a little spirit, may be used to 
moisten them. The poulticing should be changed about every eight 
hours, and continued until the morbid matter is all discharged, and 
the wound is nearly filled with healthy granulations ; when these 
have risen to the level of the surrounding skin, the wound may be 
dressed with the ointment of nitric oxide of mercury, or red-pre- 
cipitate ointment, as it is more commonly called. The constitutional 
treatment in this case should first be of an antiphlogistic kind ; aperi- 
ent, and febrifuge medicines, and low diet ; but, as soon as the car- 
buncle has been opened, and the discharge becomes copious, the 
patient's vigor must be sustained by good beef-tea, wine, and other 
nourishing condiments. Sometimes there is great prostration of 
strength, and as much stimulant is required as in typhus fever ; qui- 
nine, opium, and ammonia, are commonly given to relieve the pain 
and arouse the nervous system. Persons of a full habit of body are 
those most subject to carbuncles, which are frequently fatal if they 
are situated high up in the neck, because they are usually attended 
with inflammation of the membranes of the brain. When on the 
back or loins, although frequently of enormous size, they are not so 
dangerous. Sir Astley Cooper has remarked, that he never saw a 
patient who recovered from carbuncle on the head ; in such cases, 
there being always effusions in the brain. 



194 DISEASES OF THE SKIN AND ITS APPENDAGES. 

CHILBLAINS. 

An inflammatory affection of the skin, generally confined to the 
extremities, and especially the fingers and toes. Exposure to sudden 
alternations of heat and cold usually gives rise to these troublesome 
visitations, which are rather characterized by itching and irritation 
than pain. It seems probable that the disease is sometimes due to 
the mere contact of snow-water. Persons of scrofulous habit and 
languid circulation are most subject to them, as are children and 
aged persons. It is a popular fallacy that to keep the surface of the 
skin in a state of unnatural warmth, by hot bottles and woollen 
socks by night, and fur linings ftnd feet-warmers by day, is the best 
way to prevent chilblains ; but this only serves to keep up a con- 
stant perspiration, and so weakens the tone of the system, and in- 
creases the liability to them. A nightly foot-bath of cold, or, for 
aged persons, of tepid salt and water, with plenty of friction with a 
rough towel, and exercise during the day, will be most likely to keep 
chilblains from the feet ; and for the hands, a careful rubbing so as 
to get them thoroughly dry after every washing or dipping in water, 
and an avoidance of all unnecessary exposure to severe cold, are the 
best preventive measures. It is a good plan to have a pan of oat- 
meal always at hand, and to rub them well over with that after they 
have been wetted and wiped as dry as possible ; this will absorb any 
moisture left by the towel, and have a softening and cooling effect. 

Should chilblains come, as sometimes they will, in spite of all 
precautions, let them be gently rubbed every night and morning 
with some stimulant application. Alcohol, brandy, spirits of turpen- 
tine, or camphorated spirits of wine, are all good for this purpose ; 
but the application which will prove most efficacious is a lotion made 
of alum and sulphate of zinc : two drachms of each to half a pint of 
water, rubbed in warm ; it may be made more stimulating by the 
addition of one ounce of camphorated spirits. When the chilblains 
are broken there must be a different course of treatment ; the ulcers 
formed are often difficult to heal, especially in weakly and ill-condi- 
tioned persons ; there is generally a great deal of inflammation which 
must be subdued by means of bread-and- water poultices applied cold, 
and afterward by cooling ointments, such as the cerate of acetate of 
lead, or spermaceti ointment, with forty drops 'of extract of Goulard 
added to the ounce ; should there be a disposition to form proud 
flesh, the ointment of red precipitate should be used. The intoler- 
able itching is best relieved by a lotion made of equal parts of lauda- 
num and spirits of turpentine. 



ITCH. 195 



ITCH 

A troublesome affection caused by a parasite, known as the itch 
insect, or, as naturalists term it, Acarus scabiei. 

In its natural size, it is so minute as to be scarcely visible to the 
naked eye. The most prominent symptom of this disease is a con- 
stant and intolerable itching ; it never comes on of itself, but is al- 
ways the result of contact with an affected person. It first shows 
itself in an eruption of small vesicles filled with a clear watery fluid, 
occurring principally on the hand and wrist, and in those parts most 
exposed to friction, such as the spaces between the fingers, and the 
flexures of the joints, etc. ; after a time it extends to the legs, arms, 
and trunk, but it rarely appears on the face. The insects are often 
found in the vesicles, but not always ; hence, some have doubted 
whether they are really the cause of the diease. 

The itch is never got rid of without medical treatment ; but to 
that it will always yield, provided proper cleanliness be observed. 
Sulphur is the grand specific for it ; it may be applied in the form 
of ointment, prepared as follows : Flowers of sulphur, two ounces ; 
carbonate of potash, two drachms ; lard, four ounces : to be rubbed 
well in wherever the eruption appears, every night and morning ; 
washing it off with soap and flannel, before each fresh application. 
The most effectual plan is to anoint the whole body, from the nape 
of the neck to the soles of the feet, and out to the ends of the fingers ; 
put on socks, drawers, flannel wrapper, and gloves, and so remain in 
bed for thirty-six hours, repeating the anointing operation twice 
during that time ; then take a warm bath. In some cases alterative 
medicines may be necessary. 

Another remedy, perhaps more absolutely certain, is the follow- 
ing : 

Black oxide of manganese, 3 drachms. 

Lard, 1 ounce. 

Make an ointment, and apply as directed for the sulphur-ointment. 

The following preparation is infallible : 

Take of quicklime, . 2 ounces. 

Washed sulphur, 1 ounce. 

Water, . . . .10 ounces. 

Boil the lime and sulphur in the -water till they combine. Let it cool, pour 
off the liquor, and apply it with a cloth. 



196 DISEASES OF THE SKIN AND ITS APPENDAGES. 

BARBERS' ITCH {Sycosis). 

An inflammation of the hair-follicles, marked by snccessive erup- 
tions of small pustules, whose granulated appearance bears some re- 
semblance to the substance of a fig. It occurs on the chin and parts 
of the face where the beard grows, and is due to the development of 
a vegetable parasite. 

The treatment requires the removal of all the hairs at the dis- 
eased spot by scissors or extraction, separation of all scabs or incrus- 
tations by poultices, and destruction of the parasitic plant by lotions. 

Carbolic acid, 1 drachm. 

Glycerine, 1 ounce. 

Water, 8 ounces. 

Mix, and use as a wash. 

Corrosive sublimate, 4 grains. 

Distilled water, 3 ounces 

Dissolve for lotion. 

Sulphurous acid, 1 ounce. 

Water, . ....... 7 ounces. 

Mix. 

Any one of these will answer ; sustain the system at the same 
time by good food and tonics, quinine, and cod-liver oil. 

CORNS. 

These arise from a thickened state of the outer or scarf skin, 
caused generally by the pressure or friction of tight, or ill-fitting 
shoes ; the sensible, that is, the true skin, feeling the pressure, en- 
deavors to protect itself by throwing up a sort of defence, which as- 
sumes a conical form, having the apex within pressing upon the ten- 
der skin, and often causing, intolerable pain, and sometimes inflam- 
mation to such an extent as to form an abscess at the point. 

In the treatment of corns, the first object should be to remove 
the exciting cause ; comfortable, well-fitting boots or shoes should 
be substituted for those of an opposite character, and the corn, after 
the feet have been soaked in warm water to soften it, should be pared 
carefully away, particular care being taken not to wound the more 
sensitive part. When the outer surface is removed, there will be 
perceived in the centre a small white spot, which should be carefully 
dug out with a pointed knife or pair of scissors. When this too is 
removed, cover the seat of the corn with a small circular piece of 
thick soft leather spread with soap or diachylon-plaster, and leaving 
a small hole in the centre, corresponding with that from whence the 
root of the corn has been taken. Should any of this latter remain 



BUNION.— WARTS. 197 

so as to cause irritation, apply to it, every second or third day, a 
piece of lunar caustic scraped to a point, and slightly moistened. 
Some persons apply strong acetic or other acid ; but this is not so 
effectual, and more likely to cause inflammation, which will be best 
allayed by a warm poultice of bread-crumbs, moistened with Goulard 
water, the foot being held up as much as possible, and the system 
kept in a cool state with saline aperients. 

Soft corns, which form chiefly between the toes, are often very 
painful and troublesome ; let them be cut away as closely as possible 
with a pair of scissors and then dressed with rags wet with a solution 
of sugar of lead ; ivy-leaves form, for such, a cool, pleasant protection 
from friction ; they should be put on fresh every day. 

Beneath the corner of the nail of the great toe a peculiar kind of 
corn sometimes occurs ; it should be cut, or scraped out with the 
finger-nail, and caustic applied as above directed. Mere callosities 
of the skin on the hands and fingers are not corns, although often 
called so ; they have no roots and are not painful ; therefore it is best 
not to interfere with them, for if removed others would come in their 
places, while the friction is kept up in which they originate. 

BUNION. 

This painful and annoying swelling is the result of inflammation 
of a small bursa, situated just over the joint, at the ball of the great 
toe ; the pressure of tight shoes is generally the exciting cause, and 
all such pressure should be at once removed. During the first stages, 
one or two leeches should be applied to the swelling, with warm fo- 
mentations and bread-poultices. A permanent enlargement of the 
part is generally the result, and this must be studied in taking meas- 
ure for the boot. An application of caustic will sometimes reduce 
it considerably ; it should be kept covered with Burgundy pitch, or 
soap-plaster, spread upon soft leather. 

WARTS. 

These are excrescences from the cutis or outer skin, or horny tu- 
mors formed upon it ; they are not generally so painful as disagree- 
able and unsightly, coming nearly always upon the hands, or some 
other conspicuous place. The best treatment is to touch with some 
caustic or escharotic. Nitrate of silver is the most effectual, but 
this turns the skin black, which is in many cases very objectionable. 
Caustic potash will answer the purpose, so will acetic acid if of extra 
strength, and nitric acid. The application should be made daily, 
and the decayed part pared off, or cut with scissors. If it can be 



198 DISEASES OF THE SKIN AND ITS APPENDAGES. 

conveniently done, a ligature of silk tied tightly round the base of 
the wart will cause it to decay. 



BIRTH-MARKS AND MOLES. 

Any process by which a mole may be removed from the skin will 
leave a mark worse than the mole. Attempts have been made to 
get rid of vascular birth-marks by exciting an inflammation at the 
place of specific character, as by vaccination. Here, also, a scar must 
necessarily be left, and even this means could not be effective, where 
the marks are so large as to be deformities. The difficulty, therefore, 
is, with both, that there is scarcely a desire for removal, except where 
they are deformities and in these cases, removal will leave deformities 
equally great. 

BALDNESS— THE HAIR. 

Falling of the hair may result either from age or disease, although, 
in the former case, the age may greatly vary in different individuals, 
some becoming bald before they arrive at the middle period of life. 
This kind of baldness, like the change of color in the hair, may often 
be observed to run in families, and to be, as it were, constitutional, 
and nothing can be done to check it ; the commencement is always 
from the crown of the head, leaving a bare, shining spot, which 
spreads, with greater or less rapidity, over the whole scalp, render- 
ing, in some cases, a wig absolutely necessary; whereas, if the bald- 
ness proceeds from disease, it may commence at the top, back, or 
sides, and at several places at once. In speaking of baldness from 
disease, we refer to that from some constitutional or skin disease, 
that affects permanently the roots of the hair, and not to that which 
occurs immediately after fever, which is apparently a natural pro- 
cess ; the loss of the hair in those cases being only temporary. 

Hair is one of the common integuments of the body, consisting 
of dry, elastic filaments arising from the skin of all animals except 
fishes and reptiles, that is, of all warm-blooded animals. It grows in 
the cellular membrane, having a cylindrical root, surrounded by a 
capsule, with nerves, etc., which is called the bulb, and which is 
nourished by a fluid in the membrane. 

Exclusive of the animal matter which forms the basis of hair, and 
which is the same in all, there is a coloring matter which is sepa- 
rable from it, and the hue of which varies according to the kind of 
hair, and to which the difference of tint is owing. To this fatty sub- 
stance, also, physiologists attribute the suppleness, elasticity, and 
unalterability of hair, and also that it burns rapidly, and combines 



THE HAIR. 



199 



with alkalies to form soap. All animal integuments, such as horns, 
nails, feathers, fur, wool, are, to a certain extent, supple and elastic, 
and all are formed of the same animal matter, and include in their 
composition a portion of this oil. It has been found that hair is sol- 
uble in water at a very high temperature ; as in a Papin's Digester, 
where it leaves a residue of the oil above spoken of, mixed with sul- 
phuret of iron, and some sulphuretted hydrogen, the iron being- 
found most abundant in the darkest hair. Sulphur appears to be 
the ingredient on which the action of the black dyes of red or gray 
hairs depends. 

The whole subject of the growth and structure of the hair is one 
of the most curious and interesting connected with our animal econ- 
omy. 

Hair grows, in greater or less degree, on all parts of the surface 




The accompanying diagram will ex- 
plain how the Hair is retained in the 
skin, and, if you examine it attentively, 
you will be able to understand the rela- 
tive positions of the various parts. The 
diagram represents a section of the human 
scalp, showing the manner in which the 
Hair penetrates it : a, is the hair-follicle ; 
b, the Hair within the follicle ; c, the epi- 
dermis ; d d, the sebaceous glands open- 
ing into the hair-follicle ; e, the fatty tis- 
sue, with the cellular tissue underneath 
it, in which the base of the hair-follicle is 
embedded. 



of the body, except the palms of the hands and the soles of the feet. 
It differs considerably in length, thickness, shape, and color, accord- 
ing to situation, race, family, sex, and age. As hair is a bad con- 
ductor of heat, it is obviously one of the most appropriate coverings 
for the bodies of animals, or the head of man, because heat escapes 
very slowly through it. The surface of the body is protected from 
the influence of excessive heat, moisture, and electricity, by means 
of the hair. ' ' 

" The hair," says Mr. Paget, the eminent anatomist, " in its con- 
stant growth, serves, over and above its local purposes, for the ad- 
vantage of the whole body, in that, as it grows, it removes from the 
blood the bisulphate of protein, and other constituents of its sub- 



200 DISEASES OF THE SKIN AND ITS APPENDAGES. 

stance, which are thus excreted from the body." It is therefore 
evident that the hair performs an important part in the animal econ- 
omy. It has been remarked that shaving or cutting the hair assists 
in the removal of carbon and hydrogen from the system ; conse- 
quently long hair is injurious. 

The texture of hair differs with the color. Flaxen is the finest, 
black is the coarsest. Hair becomes coarser as it gets gray. In a 
square inch of the skin of the head there are 598 black hairs, and 
728 flaxen hairs. Race and climate influence the color. 

Management oe the Haik. — Pass a fine-tooth comb, at regular 
intervals every twenty-four hours, through the hair, in order to keep 
it from matting or entangling. Separate the hairs carefully and 
repeatedly, so as to allow the air to pass through them for several 
minutes. Use a brush that will serve the double purpose of cleans- 
ing the scalp, and gently stimulating the hair-bulbs. Before going 
to bed, it will be desirable to part the hair evenly, so as to avoid 
false folds, or what is commonly called turning against the grain, 
which might even cause the hairs to break. Such are the ordinary 
requirements with regard to the management of the hair. Some 
persons carry to excess the dressing and adornment of the hair, 
especially those who are gifted with that of the finest quality — thus, 
for example, females who are in the habit, during the ordinary op- 
erations of the toilet, of dragging and twisting the hair, so as 
almost to draw the skin with it ; the effect of which is, in the first 
instance, to break the hairs and fatigue the scalp, and finally to 
alter the bulb itself. 

Management of the Hair in Childhood. — As this is an im- 
portant branch of our present subject, future appearance and comfort 
depending greatly upon it, we shall devote some space to directions 
thereupon. Ablution and friction are the most requisite means for 
keeping the skin of the scalp in a healthy state, which is necessary 
to the proper growth of the hair. Remove the epidermis by wash- 
ing and rubbing frequently. Once a day is not too often, although 
once a week is commonly thought often enough ; and, where it is 
so, soap should be used, as simple water will not remove the tough 
and clogged epidermis which obstructs the growth of the hair. In 
the case of daily ablution there is no necessity for this ; indeed it 
would be injurious, as it would remove too much of the oily matter 
by which this growth is encouraged and facilitated. By the too fre- 
quent application of soap, the hair is rendered dry and brittle. With 
proper attention to cleanliness, it needs very little of this, or any 
solvent of oil. For the long hair of girls, occasional washing with 
the yolk of an egg may be beneficial, and for all, a little grease is 



THE HAIR. 201 

necessary about every two or three days. This, although it does 
not act as a stimulant, as many suppose, adds to the growth of the 
hair, by allowing it to escape from its follicles, or secreting cavities. 
It may be rendered stimulating by the addition of cantharides, or 
spirit of ammonia, one or other of which is no doubt employed in the 
preparation of the celebrated Rowland's Macassar. As to the kind 
of grease to be used, it is really of little consequence ; some animal 
oil is perhaps the best, the vegetable oils generally being too dry- 
ing and heating. Bear's-grease is very good, although, not perhaps 
better than any other animal fat ; hence the public do not suffer 
much by the pleasing delusion that they purchase this grease in 
the pots which are said to contain it. 

But rubbing the scalp, and combing the hair, come before greas- 
ing, and both these operations should be regularly, frequently, and 
gently performed ; if the towel be too rough, or the comb too sharp- 
pointed, or the brush too hard, there will result an improper degree 
tf irritation, and this should be guarded against. 

A change in the color of the hair may be produced by fever, or 
some other acute disease affecting the whole system, as well as by 
age; in the latter case it is gradual, and usually extends over many 
years ; in the former it is more rapid, but not so much so as the 
change produced by some powerful emotions of the mind, fear es- 
pecially, under the influence of which a person's hair has become 
perfectly blanched in the course of a few hours ; from a darker color 
to gray or white is the most common change of color, but cases are 
on record in which the sudden alteration has been from black or 
brown to red, and even from brown to black. Why this sudden 
effect should be produced by strong mental emotion, we know not ; 
if it were gradual, we might safely attribute it to a diminution of 
vital power, which is sure to ensue in the reaction after undue ex- 
citement. Such is the case in intemperance and other excesses, 
which often cause a change of color, if not a loss of the hair 
altogether. During and after pregnancy the head sometimes loses 
its natural covering; a stimulant application will generally cause it 
to grow again, especially if the patient recovers her health and 
strength. The following preparation for this purpose has been 
recommended as almost a complete specific : 

Powdered cantharides, . . . ■ , . . < 1 ounce. 

Purified spirits of turpentine, 3 ounces. 

Neat's-foot oil, 5 ounces. 

Put the first two ingredients into a bottle together, and let them stand for 
a fortnight ; strain and add the last ; shake up well, and apply to the 
head every night and morning. 



202 DISEASES OF THE SKIN AND ITS APPENDAGES. 

For removing hair from any part, the following preparation is 
effective : 

Quicklime and carbonate of potash, of each, ... 2 ounces. 

Orris-powder, 1 ounce. 

Mix and keep dry. When wanted, make a paste with water, and apply to the 
part, washing it off when dry. 

Pomade. 

Take of pure animal grease, 1 pound. 

Nut-oil, 3-£ ounces. 

Spermaceti or white wax, 1£ ounces. 

Melt the grease and spermaceti together. Add the oil, and pass the whole 
while warm through a cloth. Scent with any essence, rose, bergamot, 
or geranium. 

Dupuytren's Pomade. 

Pure beef-marrow, 1 ounce. 

Tinct. cantharides, 1 fluidounce. 

Balsam of Peru, . . ' . . . . . . 3 drachms. 

Sugar of lead, 1 drachm. 

Oils of cloves and cinnamon, of each, . . . .15 drops. 

An excellent application where the hair is falling. 

Washes for the Hair. 
Shampooing Liquor. 

Rum, 3 quarts. 

Water, 1 pint. 

Tinct. cantharides, . . -J ounce. 

Carb. ammonia, -£• ounce. 

Tartaric acid, 1 ounce. 

Mix. Rub it on, and, after, wash with water. 

Rosemary infusion, 1 gallon, 

Water of ammonia, 1 ounce. 

Tinct. cantharides, 2 ounces. 

Glycerine, 4 ounces. 

Apply with a sponge. 

Hair-Dye. 

Solution of sulphuret of potassium, . 1 drachm to 1 ounce of water. 

Solution of nitrate of silver, . . 1 drachm to 1 ounce of water. 
Moisten the hair with the potassium, and when it is dry add the nitrate of 

silver. 



NAILS. 

Like the hair, the nails may be regarded as a prolongation of the 
epidermis or outer skin. Much of the beauty of the hand depends 
on the state in which the nails are kept. Durlacher says, that, " ac- 



FAILS. 203 

cording to European fashion, they should be of an oval figure, trans- 
parent, without specks or ridges of any kind ; the semilunar fold or 
white half-circle should be fully developed, and the pellicle or cuti- 
cle which forms the configuration around the root of the nails thin 
and well-defined, and, when properly arranged, should represent as 
nearly as possible the shape of a half-filbert. The proper arrange- 
ment of the nails is to cut them of an oval shape corresponding with 
the form of the finger ; they should not be allowed to grow too long, 
as it is difficult to keep them clean ; nor too short, as it allows the 
ends of the fingers to become flattened and enlarged by being 
pressed upward against the nails, and gives them a clumsy appear- 
ance. The epidermis which forms the semicircle around, and 
adheres to the nail, requires particular attention, as it is frequently 
dragged in with the growth, drawing the skin below the nail so 
tense as to cause it to crack and separate into what are called ag- 
nails, or, more properly, hag, or hangnails. This is easily remedied 
by carefully separating the skin from the nail by a blunt, half-round 
instrument. Many persons are in the habit of continually cutting 
the pellicle, in consequence of which it becomes exceedingly ir- 
regular, and often injurious to the growth of the nail. They also 
frequently pick under the nails with a pin, penknife, or the point of 
sharp scissors, with the intention of keeping them clean, by doing 
which they often loosen them, and occasion considerable injury. 
The nails should be cleaned with a brush, not too hard, and the 
semicircular skin should not be cutaway, but only loosened without 
touching the quick, the fingers being always dipped in tepid water, 
and the skin pushed back with a towel. This method, which should 
be practised daily, will keep the nails of a proper shape, prevent ag- 
nails, and the pellicles from thickening or becoming ragged. When 
the nails are naturally ragged, or ill-formed, the longitudinal ridges 
or fibres should be scraped and rubbed with lemon, afterward 
rinsed in water, and well dried with a towel ; but if the nails are 
very thin, no benefit will be derived from scraping ; on the contrary, 
it might cause them to split. If the nails grow more to one side 
than the other, they should be cut in such a manner as to make the 
point come as near as possible to the centre of the end of the 
finger." 

The latter rule, however, will not apply to toe-nails ; they should 
be cut nearly straight across, leaving the corners, which, in conse- 
quence of the pressure of the shoe, have always a tendency to grow 
in, as they often do, producing inflammation and ulceration, and 
becoming very troublesome and difficult to heal. Indeed, a bad 
in crowing toe-nail is among the most troublesome of the minor 



204 DISEASES OF THE SKIN AND ITS APPENDAGES. 

cases with which a surgeon has to deal ; it can seldom he entirely 
cured without the removal of the nail, and, when this has become 
firmly embedded in the flesh, it is no easy matter to extract it ; then 
there is danger of inflammation, mortification, tetanus, and a whole 
train of evil consequences ; there is usually a fungoid growth in and 
about the part of the toe where the nail enters, and this must be de- 
stroyed by the free application of caustic; then, if the nail be 
scraped thin, the edge may probably be lifted out, so that a small 
piece of scraped lint, or carded cotton, can be placed under, and pre- 
vent its penetrating again, so as to irritate and keep up the inflam- 
mation. Most surgeons recommend the entire removal of the nail, 
or of that half of it to which the ingrowing edge belongs. The fol- 
lowing mode of treating this painful and annoying complaint has 
been found successful: Procure a piece of silver, rolled out suf- 
ficiently thin to admit of being bent to the required shape, yet 
sufficiently firm to bear moderate pressure. This should be nearly 
the length of the nail, from a quarter to half-an-inch wide, and bent 
into somewhat of an S shape, or rather a~b. The lower end (b) is, 
by the aid of a pair of forceps, to be carried down between the over- 
hanging ulcerated skin and the nail, and hooked under the rough 
edge of the latter. The upper end (a) is then carried outward, and 
secured in that position by a strip of plaster, and a bandage round 
the toe. By this means, the inverted edge of the nail and the skin 
are effectually kept from one another, and pressed in opposite direc- 
tions. The nail is a little elevated, and the fungoid growth very 
soon shrinks under the pressure of the metal, and assumes a healing 
aspect. After several days a marked improvement will generally be 
found to have taken place, when the silver may be readjusted, and 
allowed to remain on a longer time. Gradually the ulcer heals, and 
the nail grows up in a more natural shape. 



DISEASES OF THE BRAIN, SPINE, AND 
NERVOUS SYSTEM. 



INFLAMMATION OF THE BRAIN. 

Symptoms. — Severe pain in the head, redness of the face and 
eyes, intolerance of light and sonnd, watchfulness, and ferocious 
delirium. 

It often comes on with a sense of fulness in the head, flushing of 
the countenance, redness of the eyes, fulness of the pulse, and rest- 
lessness. Or it may make its attack with pain or a peculiar sense 
of uneasiness of the head, back, loins, and joints, or tremors of the 
limbs, and intolerable pains of the hands, feet, and legs ; or with 
anxiety, and a sense of tension referred to the breast, with palpita- 
tion of the heart. As the disease advances, the pain greatly in- 
creases, and with it the redness of the face and eyes ; the counte- 
nance acquires a peculiar fierceness, the patient talks incoherently, 
and delirium follows, and often arrives at a state of frenzy. The 
face becomes turgid, the eyes stare, and seem as if starting from 
their sockets ; tears flow from them, the patient resembling a furious 
maniac, from whom it is often impossible to distinguish him, except 
by the shorter duration of the disease. The eyes are incapable of 
bearing the light, and the least noise is intolerable ; respiration is 
deep, slow, and irregular, and swallowing difficult, the pulse being 
generally remarkably hard, small, and irregular. 

An injury immediately applied to the brain, such as violent exer- 
cise, intoxication, rage, or the head being exposed long to a power- 
ful sun ; long and intense study ; cold ; fatigue ; excessive venery ; 
indigestible and poisonous substances received into the stomach; 
and the suppression of habitual discharges, and debilitating diseases, 
are the most frequent causes. 



206 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

Inflammation of the brain is to be distinguished from inflamma- 
tory fever, by there being a much greater derangement in the men- 
tal functions and in all the organs of sense in the former than in the 
latter. In inflammation of the brain, the symptoms (as pain and 
heat of the head, etc.) denoting the local affection are often well 
marked before the pulse is much disturbed ; in inflammatory fever, 
the pulse from the commencement is frequent, strong, and rapid. 

Treatment. — Vigorous depleting measures are necessary. Com- 
mence in a vigorous person by a copious blood-letting from the tem- 
poral artery, jugular vein, or arm, through a large orifice, so that 
the blood may be rapidly extracted. Its extent and repetition must 
be regulated by the age and constitution of the patient, and by the 
severity of the symptoms; but the first bleeding should rarely be 
less than twenty ounces. This should be followed by the applica- 
tion to the head of cloths dipped in vinegar-and- water, or iced water, 
renewed as often as they show a tendency to become warm. The 
application of ice to the shaven head is here often of striking advan- 
tage. At the same time an active purgative medicine should be 
given, and a mixture of tartar-emetic containing a half-grain to a 
dose should be administered once in two hours. 

During the whole course of the disease, the patient ought to be 
kept cool, and as quiet and undisturbed as possible, light being 
almost totally excluded. The diet should be toast and water. Cold 
acidulated liquors, as lemon or orange juice, mixed with water, should 
be allowed with freedom. 



HYDROCEPHALUS. 

Water on the brain is a common result of inflammation, but the 
disease is called by the above name, as it occurs in children, from a 
conviction that it is not always an inflammatory disease. Hydro- 
cephalus seems, indeed, to arise in two exactly opposite states of the 
system : first, when there is hyperemia of the brain ; in this case it 
is inflammatory ; next, when a drain in some other organ weakens 
the system and greatly reduces the quantity of blood that circulates 
in the brain. In this case the disease is irritative. 

It often happens that, from ignorance of the premonitory symp- 
toms, the disease advances too far before medical aid is sought, 
and means are adopted which, at an earlier period of its progress, 
might prove successful in warding off the disease. The principal 
premonitory symptoms are a capricious or defective appetite, and 
irregular or torpid bowels. The urine is high-colored and scanty ; 
the skin harsh, and the complexion faded and unhealthy. Languor 



HYDR CEPHAL US. 207 

and frequent drowsiness are often present, with disturbed sleep ; 
there are, also, occasional attacks of giddiness and headache. The 
child loses its spirits, and becomes taciturn and grave. As the 
disease makes progress, the child, if not able to speak, may fre- 
quently put its hands to its head ; the eyebrows are knit ; there 
may be lameness or feebleness in its gait if it walks. The stomach 
begins to reject food, and vomiting soon forms one of the most ob- 
stinate symptoms. The bowels are disordered. The child grinds 
its teeth in sleep, sleeps with its eyes open, starts or wakes up in 
alarm. 

There is, in children suffering under the affection of the brain, a 
sharp, short, peculiar, plaintive cry. The symptoms will usually be 
observed to be worse at night. The duration of the disease may be 
several weeks. If, as the disease progresses, the inflammation ex- 
tends from the brain down the spinal cord, the body of the child 
becomes stiffly bowed backward. It usually terminates by convul- 
sions, perhaps of one side only of the body, or of one limb only, and 
coma caused by effusion of serum on the surface of the brain ; hence 
its name, " water on the brain." 

There will always be, early in the disease, some of the following 
distinctive characteristics : 

Change in the eye. It is intellectually dull ; the pupil, at first 
smaller than natural, becomes greatly dilated ; subsequently, the two 
pupils may be of different size, and the eyes do not act together ; 
irregularity of the pulse, irregularity of the respiration, rolling of 
the head on the pillow, and clenching the fists convulsively, with 
the thumb inside. Headache, constipation, and vomiting, are symp- 
toms whose coincidence should excite suspicion of this disease. 

In treating this disease, it should be always at first determined 
whether the disease is of the inflammatory or the other class. If it 
is of the irritative form, and is treated for inflammation, the treat- 
ment will aggravate the troubles. 

In the inflammatory variety of the disease, we must moderate 
and reduce the circulation through the brain ; in the other variety, 
we must stimulate the same circulation. For the first form, apply 
cold water to the head. An efficient sedative is the letting cold 
water fall, drop by drop, upon the scalp, until the head remains cool 
on intermitting the operation. There is great danger in pushing 
this too far. Or an india-rubber water-cushion may be used for 
keeping the head cool : it should be filled to one-half only of its 
capacity with iced water, and the little patient's head laid upon it, 
so that the nape of the neck and the back of the head will lie on the 
middle of the cushion. As the fluid becomes warm, which usually 



208 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

occurs in half an hour, the cushion should either be recharged with 
fresh iced-water, or replaced by another already charged. When 
the child expresses dislike to the cold cushion, it is the best indica- 
tion that the period for using it without recharging it may be 
gradually extended, or that it may be altogether laid aside. 

Give to a child, from one to ten years, one to two grains of calo- 
mel, combined with three times the quantity of powered jalap, and 
repeat or not as the symptoms increase in severity, or remain 
stationary. 

In the irritative variety, that includes perhaps five in six of the 
cases, the real trouble is in the abdomen, not in the brain ; the 
brain is only sympathetically irritated, and enfeebled by disorder 
of the liver and intestines. To a child in whom continued disorder 
of the bowels is suddenly followed by head-symptoms, give two 
grains of calomel and six of jalap, and in two hours begin with the 
following mixture : 

Take of Epsom salts, ....... 2 drachms. 

Syrup of orange-peel, 2 drachms. 

Caraway-water, 6 drachms. 

Mix, and give two teaspoonfuls every hour to a child three years old, un- 
til the bowels act freely. 

After the bowels have been effectually opened by the preceding 
means, they must be kept so by giving through the succeeding days 
the following mixture, and every night two grains of gray powder 
and three of rhubarb, in jelly : 

Take of nitrate of potash, 10 grains. 

Epsom salts, 1 drachm. 

Syrup of lemons, ..... 3 drachms. 

Distilled water, 9 drachms. 

Mix, and give three teaspoonfuls, thrice a day, to a child two years old. 

By these means a free action on the bowels and kidneys may be 
secured, day by day, which is of the first consequence. 

But with this treatment must be associated the more or less 
active use of stimulants or cordials to stimulate circulation in the 
head, for the fatal result of the abdominal disease occurs through 
exhaustion, inducing disease of the brain. The tincture of opium in 
doses too small to induce sleep stimulates in exactly the right way 
for the first stage of the disease. Aqua ammonia in doses of five or 
ten drops once in two hours, and five or ten drops of brandy in the 
interval, act well. Powder of ipecac, in grain-doses, given once or 
twice a day, will do more than any other single medicine to restore 
the intestines to right action. Never blister a child in either form 
of this disease. 



APOPLEXY. 209 

The diet must be very simple, light, and cooling, consisting 
chiefly of barley-water, toast and water, and thin gruel. In raising 
the patient to take food, medicine, etc., all quick, rough movements 
must be carefully avoided. It is of no small importance that the 
patient should be kept perfectly quiet, and be seen by none but 
the few persons necessarily required to attend him, and that for 
some days after the disease has been subdued. In recovering, a re- 
turn to the ordinary food must be made slowly and very cautiously. 

Any appearance of precocity of intellect in the children of a 
family in which hydrocephalus has occurred should be checked; 
and parents ought to be fully aware of the hazard of too early, or 
too long-continued, mental application in such cases. The vigor of 
the body should be cherished, and the powers of the intellect left at 
fallow until the strength of the constitution is established. The ut- 
most care must be taken to support the tone of the habit by mild, 
nutritious diet, daily exercise, and good air. Nothing is more im- 
portant, in the management of children of a hydrocephalic tendency, 
than the daily examination of the evacuations. When these are 
pale, slimy, offensive, or in any way unusual, the child should re- 
ceive immediate attention in this respect. 



APOPLEXY. 

There are two varieties of apoplexy, which are in general clearly 
marked, the one attended with a hard, full pulse and flushed counte- 
nance; the other with a feeble pulse and pale countenance. In the 
former, when the patient falls down in a state of insensibility, or 
stupor, out of which it is impossible to rouse him by any of the ordi- 
nary means, his face is generally red or purple, the breathing 
difficult and stertorous; the upper-lip margin is projected at each 
expiration ; the veins of the head and temples protrude as though 
overfilled, the skin is covered with perspiration, and the eyes are 
fixed and blood-shot. In the second form, with the pale face, there is 
a look of misery and dejection, and the pulse, instead of being full 
and hard, is weak and intermitting. The former usually occurs in 
persons of a full, plethoric habit, and considerable energy and 
strength ; the latter, for the most part, in the cold, phlegmatic, and 
feeble. Generally speaking, the latter form of the disease is the 
most dangerous, since, from the general failure of the energies of 
life, Xature has less ability to assist the use of our remedial measures. 
In other points of view, the degree of danger will be generally 
measured by the violence of the symptoms. In general, the shorter 
the fit the more favorable the prognosis. 



210 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

Whatever operates in determining a great quantity of blood to 
the head, or in impeding a free return from it, may produce exces- 
sive distention or effusion within the cranium, and be, therefore, 
reckoned as exciting causes : such as violent passions of the mind, 
immoderate exercise, intense study, fits of intemperance, excessive 
straining, ligatures about the neck, the suppression of accustomed 
evacuations, as piles, etc., unrestrained indulgence of the appetite, 
and exposure to sudden and great heat, or to excessive cold. 

Apoplexy is distinguished from epilepsy, or falling fits, by the 
presence of convulsions and contortions of the limbs in the latter, by 
the comparative shortness of the fit, and the greater facility with 
which the patient is roused. 

In deep intoxication, the breath is in general tainted with the 
intoxicating liquor, and the patient may be in some degree roused 
by shouting in his ear, and by applying a strong stimulus to the 
nostrils. These will be without effect in apoplexy. 

Tkeatment. — In a case of the first variety, so soon as the patient 
has been placed in a sitting position, with the legs depending, every 
thing about his neck removed, and the air freely admitted, a vein 
should be opened in the neck or arm, and the blood allowed to flow 
until the pulse is greatly reduced ; a pallor in the face, and a gen- 
erally relaxed state of the muscles, show that fainting is about to 
ensue. In a case of the other variety it is necessary also to relieve 
the neck of all pressure, to place the body upright, and admit air — 
but beyond this the treatment must be different ; cold water should 
be dashed in the face, strong spirits of ammonia applied to the nos- 
trils, and the feet put into a warm bath with a little mustard, and 
every means taken to arouse the patient from his state of lethargy ; 
as soon as this is so far effected that he can swallow, give half a 
drachm of aromatic spirits of ammonia in one and a half ounces of 
camphor-mixture, as a stimulant draught, but it is only when the 
pulse is feeble and fluttering that the stimulant may be administered ; 
this is the exceptional case in apoplexy ; most commonly the symp- 
toms are those first described, and if relieved at all it must be by free 
bleeding and other measures of depletion. Purgatives must be got 
down as soon as possible, ten grains of calomel placed on the tongue, 
and washed down with a black draught, or two or three drops of 
croton-oil may be rubbed on the back of the tongue, and a lavement 
composed of two tablespoonfuls of common salt, with a little oil or 
butter, and a pint of warm water ; or a tablespoonful of soft soap mixed 
with the same quantity of water ; or an ounce of spirits of turpen- 
tine, rubbed down with the yolk of an egg, and a pint of thin gruel : 
one of these should be repeated every two hours until some decided 



APOPLEXY. 211 

effect is produced. Other means of relieving the system may be 
taken, should these fail, such as blisters behind the ears, to the nape 
of the neck, or calves of the legs ; should the head be very hot, let 
it be shaved, and a cold lotion be applied »to it. 

Numerous cases of apoplexy occur where the symptoms depend 
upon irritation or loss of nervous power, and a deficient circulation 
of blood through the brain, and in which the loss of the smallest 
quantity of blood is always injurious, and invigorating means are 
indicated. This fact ought never to be lost sight of. There are 
many cases of apoplexy continually occurring, in which, at the time 
of seizure, there are present symptoms of deficient vital energy of 
the brain and constitution, although considerable corpulence may 
exist, or general appearance of strength ; thus, in the commencement 
of the attack, and before reaction has supervened, the countenance 
may be pallid or sunk, the pulse of the arteries of the neck weak or 
small, the temperature of the head not greatly increased — and in 
such cases we must not bleed until reaction has followed, but ad- 
minister gentle stimuli, as sal volatile and water internally, apply* 
the volatile salts to the nose, and dash cold water freely over the 
head and face. After the patient has recovered a little, the face 
becomes flushed, and the arteries of the neck manifest an increased 
action, we may have recourse to bloodletting with great afety and 
advantage. 

In all cases, after the crisis of the disease is over, and when the 
patient has become convalescent, it behooves him to be very careful, 
as a slight indiscretion may bring on a fresh attack. 

The best plan of management, in order to escape from another 
attack, is to live almost entirely throughout future life upon vege- 
table food, and to abstain from wine, spirits, and malt-liquor. It 
will be of considerable advantage to avoid any strong or long-con- 
tinued exertion of the mind. In some instances, when the full state 
of the vessels of the brain has for some time subsided, considerable 
advantage may be derived from the moderate use of tonic medicines, 
and more especially iron. 

Apoplexy never comes without warning. However sudden the 
attack itself may be, there are certain premonitory symptoms which 
no prudent man will disregard ; among these may be named a sense 
of fulness in the veins of the head, and a feeling of pressure in the 
head itself, with occasional darting pains, giddiness, vertigo, partial 
loss of memory, and the powers of vision, and of speech ; numbness 
of the extremities, drowsiness, and a dread of falling down ; irregu- 
larity in the action of the bowels, and involuntary passage of urine. 
These all indicate that some internal mischief is going on, and, if 



212 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

their warning is attended to, the threatened attack may, perhaps, be 
avoided. Persons whose full habit of body and modes of life pre- 
dispose them to this disease should, when such warnings reach them, 
live sparingly, avoid stimulants, especially fermented and spirituous 
liquors, take regular and moderate exercise, sleep on a firm pillow 
with the head elevated, and nothing round the neck to impede the 
act of breathing. Keep the bowels regulated by an occasional dose 
of colocynth and calomel pills, and saline purgatives. Those of a 
spare habit should take light, although nourishing diet, a little beer 
or wine, if they have been accustomed to it, and it does not affect 
the head ; spirituous liquors and hot spices should be avoided, and 
great bodily fatigue or nervous excitement of any kind. 



PARALYSIS OR PALSY. 

Paralysis is a loss of the power of motion and sensibility in cer- 
tain parts of the body. Sometimes the powers of voluntary motion 
alone are affected in any considerable degree, while those of sensa- 
tion are only rendered a little more obtuse ; at other times, however, 
both kinds are equally torpid, and sometimes several of the faculties 
of the mind participate in the debility. It usually comes on with a 
sudden, though slight, loss of the power of motion in the parts 
affected, which is frequently preceded by a numbness, coldness, and 
paleness, and sometimes by convulsive twitches. In some cases, 
this loss of motive power continues to increase till it becomes com- 
plete; in others, it is stationary and partial. "When the head is 
much affected, there is distortion of the features, the memory and 
judgment are impaired, and the speech is indistinct and incoherent. 
If the disease affects the limbs, and has been of long duration, it pro- 
duces a considerable flaccidity and wasting in the muscles of the 
parts, and thus causes its own perpetuation. 

The progress of the disease is uncertain. If there be no chronic 
debility, or other morbid condition of the brain, the patient will 
sometimes recover entirely in a week, or even less ; but, if this sys- 
tem, or some particular part of it, be in an infirm state, he recovers 
only imperfectly, and obtains, perhaps, a thorough or a limited use 
of the lower limb, while the upper remains immovable ; or he is 
compelled to pass the remainder of a painful existence with only one- 
half of his body subservient to his will. 

One common cause of paralysis is pressure upon or disease of the 
brain or spinal cord. The exact seat of the disease, whether in the 
brain or spine, can only be determined by knowledge of the anatom- 
ical relations of the paralyzed nerves. But paralysis often occurs 



PARALYSIS, OR PALSY. 213 

where there is no organic disease of either brain or spine, but only 
an irritation of these due to disease in other organs, as the stomach, 
heart, kidneys, womb. Gout and rheumatism are frequent causes of 
paralysis. Some physicians hold that the greater number of cases 
of paralysis are of this nature. These are the most favorable cases. 

Treathext. — Determine first the nature of the case. Is it of the 
" reflected " kind, due to irritation in a distant organ, or does it de- 
pend upon actual spinal or brain disease. Chronic inflammation of 
the uterus, change of position of the uterus, cancer in the uterus or 
rectum, hysteria, disease of the kidneys, bladder, stomach, may 
any of them cause paralysis, and, if any of these are present, they 
alone are probably the source of the mischief, and a cure can only 
result from effective treatment of these diseases. Syphilis, rheuma- 
tism, gout, and the poison of mercury and lead (as in painters), 
induce paralysis also ; and it is useless, for these forms, to direct our 
activities toward a supposed change in the brain or spine. 

In spinal or cerebral paralysis, the proper treatment, in the 
case of a patient of a full habit, will be bleeding and cupping in 
the neck, and strong purgatives, about five grains of calomel, fol- 
lowed by senna-mixture, or croton-oil pills every four hours, until 
they operate freely ; when there are faintness and confusion of intel- 
lect, give a teaspoonful of sal volatile in a glass of water, and repeat 
it in an hour if required ; no alcoholic stimulant must be adminis- 
tered ; put the feet and legs in a hot mustard-bath, and place the 
patient in a warm bed, with the head and shoulders well raised. 
Follow up the cupping in the neck with a blister, and, after that, 
put in a seton, if required ; after they have once acted well, keep 
the bowels gently open with rhubarb or castor-oil ; let the diet be 
spare, and the quietude of the patient as perfect as possible. After 
the acute stage of the disease has passed, local stimulants should be 
used, and the affected parts well rubbed with the hand, or a flesh- 
brush. Electricity and galvanism may also be employed, where 
there is no reason to suspect structural disorganization. In para- 
plegia it is often very difficult to get the bladder to act ; and, when it 
does, the urine flows from it involuntarily ; great attention should 
be paid to this, and stimulant diuretics given ; the tincture of can- 
tharides, in half-drachm doses, is perhaps the best. 

In some cases, much relief has been afforded by the use of sul- 
phur-baths and chalybeate waters, such as those of Harrowgate and 
Baden. Mercury, which is strongly recommended by some, is but 
a doubtful remedy. Strychnia has proved serviceable, but should 
only be given in exceedingly small quantities. Put one grain in a 
mixture for thirty doses. Repeated moxae along the course of the 



214 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

spine, and small blisters on the insides of the legs and thighs, are 
recommended by Dr. Graves. 

Painters' colic is a common prelude to paralysis, resulting from 
the absorption of lead into the system ; its symptoms are similar to 
those of colic generally, with partial paralysis superadded ; some- 
times this latter symptom will show itself while the patient is in an 
average state of health, and previous to or conjointly with the 
writhing pains in the stomach, cramp in the legs, and pains in the 
head and limbs ; but more frequently there will be two or three at- 
tacks of the colic before the paralysis comes on. 

Put the feet and legs in a mustard-bath, and give a full dose of 
calomel and opium, followed in about an hour with one of castor- 
oil ; the injection of warm water into the bowels frequently affords 
great relief; if they are not freely opened by the above means, 
stronger purgatives should be given, such as colocynth and calomel, 
or one drop of croton-oil with castor-oil. Active and continued 
purgation carries the absorbed lead out of the system. From the 
first or second attack of painters' colic persons generally recover ; 
but, unless the occupation is changed, other attacks will follow, and 
the patient will become a miserable cripple. 

Shaking palsy is a form of paralysis in which to loss of power 
are added loss of control and tendency to involuntary movements 
of the muscles. Tonics are the only remedies of any value. 



EPILEPSY. 

This disease comes on at irregular periods, and the attack is for 
the most part sudden, and without any warning ; the patient may 
be about his ordinary occupation, or talking cheerfully with his 
friends, who are perhaps startled by a loud and fearful cry ; a con- 
vulsive spasm passes over the face, which is drawn on one side, the 
lower part of it being turned to one shoulder ; the eyes are set and 
staring, or rolling wildly in the head ; the color of the skin becomes 
dark and livid, and the veins swollen and turgid ; there are frothing 
at the mouth and a kind of choking noise in the throat ; all control 
over the limbs is lost, and the body falls to the ground unless sup- 
ported. Sometimes the arms are thrown about at random, while 
the fingers clutch at whatever comes in their way, digging the nails 
deeply into it, if a soft substance ; the tongue is bitten through by 
the teeth, and the struggle, as against some invisible enemy, is 
frightful to look upon. After a shorter or longer period, the con- 
vulsive movements gradually diminish, and the patient seems to 
recover a faint glimmering of consciousness, but the look which he 



EPILEPSY. 215 

casts around is stupid and heavy, and he goes off into a lethargic 
sleep, from which he does not awake for some hours ; even when 
he does, his mental perceptions appear to be very much blunted, and 
it may be days before he fully recovers from the effects of the at- 
tack. He does not remember the fit. This is a severe form of 
epilepsy. It occurs in milder forms, and is sometimes so light as to 
cause only a temporary inconvenience. That there is no warning of 
the attack should be understood to apply to lookers-on ; for the patient 
is generally aware when one is impending, by certain symptoms, 
which, after the occurrence of one or two paroxysms, he knows how 
to distinguish. These symptoms vary, according to constitution and 
temperament ; they may be lowness of spirits, with unusual irrita- 
bility, diminution or increase of energy, dizziness, noises in the ear, 
specks floating before the eyes ; but the most marked symptom • is 
called the " epileptic aura," a kind of creeping sensation, felt first at 
the extremity of a limb, and then gradually extending over the 
whole body, and into the head. 

The involuntary laughing or weeping, and the sensation of a 
globe rising in the throat, which accompany hysterics, will suffi- 
ciently distinguish this disease from epilepsy. (For the signs dis- 
tinguishing it from apoplexy, see that article.) 

In epilepsy there is always a diseased state or disorder of the 
brain, or spinal marrow ; and, this predisposing cause present, vari- 
ous circumstances may excite the fit, as sudden alarm, great sorrow, 
indulgence of appetite, suppression of discharges, use of liquor, any ir- 
ritation in the stomach or intestines, as tape-worm, and heart-disease. 

When the fit is actually present, the patient should be placed on 
a bed or sofa, the head somewhat raised, and those parts of the 
dress removed that are likely to press upon the vessels of the neck. 
In order to prevent the tongue being injured by the spasmodic 
action of the muscles of the jaws, a piece of soft wood, or a napkin 
properly rolled up, should be introduced between the teeth. Do 
not apply acrid stimulants to the mouth and nose. 

Nearly every remedy known to the materia medica has been tried 
in this disease, and every one is condemned for failure and lauded 
for success. But little can be done by domestic application of medi- 
cines, and yet the domestic practice is perhaps the most important 
part of any curative plan, since it consists, above all, in so ordering 
the patient's daily life as to prevent, so far as may be possible, the ex- 
citing causes that give rise to the fits. Any one soon finds out this 
exciting cause in his own case. A woman, for instance, knows that, 
if her courses come two or three days later than the proper time, she 
will have a fit. A man knows that excessive fatigue, over-indul- 
15 



216 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

gence of sleep, or giving way to the demands of some particulai 
appetite, provokes a paroxysm. All this extensive part of the treat- 
ment is completely in the patient's hands, and, if he will not attend 
to it, no other can. 

Beyond this, remedies that prevent spinal or cerebral congestions 
are the only ones of any permanent value. Bromide of potassium, 
ergot, and belladonna, are the best of these. Belladonna may be 
given for a long time together, in doses of one-sixth of a grain of the 
extract, or even less. Give the bromide of potassium in doses of 
twenty to forty grains twice a day. 

HYSTERIA. 

This is almost exclusively a disease of girls and women, but 
boys and young men of effeminate organization are sometimes af- 
flicted by it. It originates in a diseased or disordered state of the 
reproductive organs, though to the ordinary observer there may be 
no very evident sign of this. The disorder may be only an undue 
excitability of function, or there may be organic disease. All the 
morbid manifestations appear in irregularities of nervous action, and 
through these vagaries hysteria is apt to assume the character of 
nearly every other known disease. Paralysis of one or both arms, 
or legs, or of the bladder, may have no other cause. Insensibility to 
pain is very common with it, and undue sensitiveness to pain equally 
so. This latter causes the victim to associate her disease with some 
part of the body that may be quite healthy. She will complain of 
pain in the side, and this pain has been treated as pleurisy ; of pain 
in joints, and this has been treated as inflammation ; and hip-joint 
disease. Women have been operated upon for stone in consequence 
of their complaints of trouble in the bladder, when the disease was 
hysteria. Ordinarily these errors may be avoided by noting the 
absence of inflammation and fever, and the character of the patient. 

The common appearance of the disease is in the hysteric fit, but 
it sometimes makes its invasion in a less evident way. The hysteric 
fit may be so violent as to be confounded with epilepsy. In epilepsy 
the fit comes on immediately, and the loss of consciousness occurs 
at once. The hysteric fit gives warning. There is an uneasy feel- 
ing as of something wrong, an altered manner, and the sensation of 
a ball in the throat (globus hystericus) is constant. This feeling is 
caused by a spasm of the oesophagus. The spasm closes that canal 
gradually from below upward, and thus gives rise to the thought 
that it is closed by some foreign body. " Nervous people " say they 
feel the heart in the throat, and this is an analogous effect. The 
hysteric fit is apt to follow some mental excitement, as fright, disap- 



HYSTERIA. 217 

pointment, or distressing grief. There may be laughter, or tears, 
equally without reason, and plaintive cries, and convulsive move- 
ments of greater or less severity ; cries are more likely to close the 
fit than begin it. At the close there is a considerable flow of limpid 
urine. Altogether the general aspect of one in an hysteric fit has not 
the frightful character of epilepsy. It much more resembles maud- 
lin drunkenness ; and this resemblance is so striking, that it is diffi- 
cult for the most positive assertion to silence the uncharitable 
speeches of chance spectators. 

In the non-convulsive form of the hysteric fit, the woman simply 
has " a bad spell." She feels as if she would faint, her face flushes, 
or becomes ghastly, and she is oppressed and prostrate ; and from 
an access of this character she may remain ill for some days, lying 
like one in fever, except that she has no fever. An access of this 
sort is more apt to aggravate from time to time the state of a 
woman who is permanently the victim of hysteria. 

Treatment. — Remember that the hysteric fit is usually more 
alarming than dangerous. Give an adult from twenty drops to a 
teaspoonful of the compound spirit of ether, and force a tumblerful 
of ice-cold water down the throat, holding the teeth apart with the 
corner of a folded napkin. Camphor will do to replace the ether in 
an emergency, but is less effective. Spirits of hartshorn will answer 
the same purpose. This may also be applied to the nostrils. Take 
care, however, not to keep it there too long. If the disease should 
prove to be epilepsy, the unconscious victim will not push the bottle 
away, and the continued inhalation of the irritant gas will cause in- 
flammation. Remedies of this sort will break up or shorten the fit. 
In the non-convulsive form make a less vigorous use of the same 
remedies as the " bad spell " comes on. 

In the interval of the fits treat the hysteric condition. Much 
may be done by a proper regulation of the patient's life. Occupa- 
tion, moderate exercise, good but not rich diet, and the adoption of 
stringent rules in regard to sleep, and the time spent in bed, are the 
principal points in the case. The patient should be permitted to re- 
main in bed only while actually in sound sleep. There should be a 
regular use of the cold bath. Keep the bowels open with a simple 
aperient, and give nervines and tonics. The best tonic is the car- 
bonate of iron in the mixture called Valet's mass. This may be 
made into pills of three grains each, and from six to twelve of these 
should be taken daily for months together. Give the ammoniated 
tincture of valerian in doses of half a drachm once in three hours. 
An efficient mixture, for warding off the fits where constant recur- 
rence seems imminent, is the following : 



218 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

Ammoniated tincture of valerian, . . . . . 1 ounce. 

Spirits of camphor, 4 drachms. 

Tincture of ginger, 4 drachms. 

Mix. Give a teaspoonful every three hours. 

Tincture of ginger . should be added to all mixtures given in 
hysteria, as a constant cause of the aggravation of the disease is 
the gas that accumulates in the intestine'. Should the mixture seem 
to lose its effect, give the following pill : 

Extract of belladonna, . 2 grains. 

Make ten pills. One to be taken every four hours. 

This will permanently control the access. Indeed, it is held by 
some physicians to be an absolute cure. 

Even after the immediately curative treatment is laid aside, 
adhere to the regulations for the patient's habits, and give vegetable 
tonics — gentian, calumbo, and chiretta. 



CATALEPSY {Trance, Ecstasy). 

There is sudden deprivation of sense, intelligence, and voluntary 
motion, the patient remaining in the same position, during the par- 
oxysm, as at the moment of attack, or as placed in during its con- 
tinuance ; the pulse and respiration little affected, or so feeble as 
scarcely to be perceptible. The eyes fixed, open or shut ; pupils con- 
tracting on the application of a strong light. The evacuations are 
either suspended during the fit, or passed involuntarily. Restoration 
generally occurs suddenly; with headache, sense of fatigue, etc. 
No recollection of what has occurred in the fit. The suspended train 
of ideas resumed at the moment of recovery. Terminates in health ; 
sometimes, however, in insanity. Preceded by mental excitement 
of a religious or other character, it constitutes ecstasy. 

The hysterical or melancholic temperament predisposes to this 
disease, and it is excited by depressing passions ; prolonged or vio- 
lent mental impression ; anxiety ; unrequited affection ; religious 
contemplation. 

Treatment. — Sprinkling or dashing with cold water ; stimulants, 
such as ether or sal volatile ; friction and counter-irritation to spine 
or extremities. After the fit, tonics should be taken for some time. 
Regard it, for purpose of treatment, as a form of hysteria. 

LOW SPIRITS {Hypochondriasis). 

This is a state of mind generally associated with dyspepsia, in 
which all kinds of imaginary evils are conjured up, and the slightest 



CHOREA. 219 

pain, or unusual feeling, is looked upon as the precursor of some 
dreadful malady ; persons so affected always fancy themselves on the 
verge of danger, and hence are fearful and irresolute in the steps 
they are called upon to take ; they may be of sound mind in other 
respects, but in regard to their own bodily state and condition are 
decidedly monomaniacs. The affection appears to depend upon a 
want of energy in the brain, the causes of which are various : it may 
arise from intense study, some great stroke of affliction, indolence 
and inactivity, or indulgence in venereal or other excesses, or de- 
ranged digestion. In either case the patient should be treated with 
gentleness and consideration, so as to show that interest is taken in 
his welfare ; he can never be either laughed or forced out of his de- 
lusion, therefore the endeavor should be made to direct his attention 
— to take him out of himself as it were. Change of scene, cheerful 
society, engaging the mind in some art or pursuit, which, although 
not too laborious, requires the use of the mental powers, exercise, 
tepid and shower baths, are among the remedial measures in this 
case. The bodily health must be carefully watched and preserved 
by such means as may be necessary. 

CHOEEA {St. Vitus's Dance). 

After some time of indefinite ill-health, such as derangements of 
the stomach and bowels, diminished activity, fretfulness, etc., irreg- 
ular movements of the voluntary muscles are observed. Twitchings, 
etc., of the muscles of the face are probably first noticed. The ordi- 
nary movements of the arms and legs become interfered with by 
involuntary jerking of the muscles, so that the patient has a jump- 
ing, starting, or palsied walk. Speech and articulation become dif- 
ficult, the mouth distorted, the eyes roll about, and as the disease 
becomes confirmed the movements of the limbs are convulsive and 
grotesque. The bowels are generally costive. 

This disease is much more frequently seen in girls than in boys. 
Its most common period of life is from seven to fifteen years ; but it 
may occur later. Nervous temperament ; hereditary predisposi- 
tion ; any thing that causes general debility or depression of the 
vital powers, as excessive or premature exertion of the intellect, 
affections, or passions ; derangements of the digestive organs ; in- 
sufficient diet ; impure air ; any one of these may predispose the 
system to this disease. The exciting causes are: fright; irrita- 
tion of worms ; irritation of cutting the permanent teeth ; rheumatic 
fever ; the influence of imagination ; concealed mental emotions ; cos- 
tiveness ; irregular or retarded menstruation. 

Continued administration of moderately active purgative medi 



220 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

cines, as rhubarb, senna, or jalap, or podophyllin in very small 
doses — quarter of a grain — will generally relieve. Give also metal- 
lic tonics. 

Take of sulphate of zinc, 20 grains. 

Extract of gentian, -£ drachm. 

Mix, and divide into twenty pills ; three to be taken in the course of each day. 

An effective remedy is the tincture of cimicifuga in doses of 
twenty to forty drops, three or four times a day. 

The calabar-bean is recommended for its efficacy, but it is a dan- 
gerous agent. 

CONVULSIONS. 

The chief symptoms of convulsions are violent spasmodic affec- 
tions, with or without intermission. Previous to their coming on 
there are generally giddiness, coldness of the extremities, dimness of 
vision, tremblings, and a creeping chill up the spine. When the fit 
is on, the teeth chatter, the tongue is protruded, and often bitten, 
there is foaming at the mouth, the eyes roll wildly, there is a strug- 
gle for breath, and a clutching of the hands. 

The cause of convulsions is always an irritation in some vital 
part of the system, the intestines, the womb — or poison in the blood 
(uraemia), due to disease of the kidneys. 

During the fit, take the same precautions as are laid down for 
epilepsy. Pour cold water on the head, but moderately. If this is 
done while the body is in a warm bath, it will be more effective. 
Give an active purgative, as croton-oil, one or ' two drops, on butter 
placed far back on the tongue. Give chloroform, by inhalation, in 
small quantity. 

LOCKED JAW {Tetanus). 

Violent painful spasms of the muscles of the body, limbs, or 
throat and jaws, producing a state of rigidity, which resists every 
attempt to bend the joints, constitute the essential fact. This rigid- 
ity is continuous, and without intervals of relaxation. The mind 
is unimpaired, and the sensibility of the surface remains in its natural 
state, or may even be exalted, so that to touch any part shall pro- 
duce great aggravation of the painful muscular action. Sometimes 
those muscles only which hold the body upright are affected, and the 
body is then bent backward ; in other instances the body is bowed 
firmly forward. The trunk is so rigid that it may be raised to 
the feet without the joints yielding. In children locked jaw some- 
times occurs without spasm of other muscles. A temporary locked 
jaw often occurs from cold, or from inflammation of the ligaments 



NEURALGIA. 221 

following the extraction of a tooth. The disease generally begins 
with severe spasms about the chest and neck, recurring at short in- 
tervals. 

Wounds, scratches, and other injuries, excite irritation of 
nerves, that in turn excite the spine. A hot climate predisposes ; 
but it is also met with in temperate climates. It is very rarely 
known to occur without some wound or injury ; sometimes, especial- 
ly with children, however, it originates from irritating matters in 
the intestines, or from some morbid condition of the nervous system. 

Treatment. — Strong purgatives, such as turpentine and castor- 
oil, or croton-oil ; and one or two grains of opium, repeated at regu- 
lar intervals of from four to six hours. Large quantities of opium 
are sometimes borne without harm in this disease. Carbonate of 
ammonia, and sulphate of quinine and wine or brandy, are active 
and useful remedies. But, as the malady is one of a very danger- 
ous character, medical advice should be sought at any inconven- 
ience. Perhaps the most promising plan of treatment for domestic 
use is, to give very large doses of the bromide of potassium, say 
twenty to sixty grains every two hours. Some cures have been 
made with tobacco, and some with aconite, and still others with 
the calabar-bean. 

Temporary locked jaw, caused by inflammation of the joint aris- 
ing from diseases of the teeth, etc., is relieved by leeching, and blis- 
tering, and the subsequent application of tincture of iodine. 

NEURALGIA 

This is a painful affection of the nerves : when it occurs in those 
of the face, it is termed face ague, or tic-douloureux ; when it affects 
the great nerve of the leg, it is called sciatica ; other parts, such as 
the fingers, the chest, the abdomen, etc., are also liable to this 
agonizing pain, one of the most severe and wearing to which the 
human frame is liable ; the exact .nature of it is not very clear ; that 
is to say, the origin of the disease, for although its immediate seat 
is a nerve, or set of nerves, yet there must be some originating 
cause. It can frequently be traced to some decay, or diseased 
growth of the bone about those parts through which the nerves 
pass ; and in some severe cases it has been found to depend upon 
the irritation caused by foreign bodies acting upon those highly- 
sensitive organs. The only symptom of neuralgia, generally, is a 
violent darting and plunging pain, which comes on in paroxysms ; 
except in very severe and protracted cases, there is no outward 
redness, nor swelling, to mark the seat of the pain, neither is there 



222 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

usually constitutional derangement, other than that which may be 
caused by want of rest, and the extreme agony of the suffering 
while it lasts, which may be from one to two or three hours, or 
even more, but it is not commonly so long. Tenderness and swell- 
ing of the part sometimes occur, where there has been a frequent 
recurrence and long continuance of the pain, -which leaves the 
patient, in most cases, as suddenly as it comes on ; its periodic re- 
turns and remissions, and absence of inflammatory symptoms, are 
distinctive marks of the disease. Among its exciting causes, we 
may mention exposure to damp and cold, especially if combined 
with malaria ; and to these influences a person with a debilitated 
constitution will be more subject than another. Anxiety of mind 
will sometimes bring it on, and so will a disordered state of the 
stomach, more particularly a state in which there is too much acid. 
As for treatment, that of course must depend upon the cause : if 
it is a decayed tooth, which, by its exposure of the nerve to the 
action of the atmosphere, sets up this pain, it should be at once re- 
moved, as there will be little peace for the patient until it is ; if co- 
existent with neuralgia there is a disordered stomach, efforts should 
be made to correct the disorder there. If the patient is living in a 
moist, low situation, he should at once be removed to a higher 
level, and a dry, gravelly soil. Tonics, such as quinine and iron, 
should be given, and a tolerably generous diet, but without excess 
of any kind. Give the sulphate of quinine, two or three grains a 
day, and the carbonate of iron in much larger doses — six to twelve 
grains three times a day in pills — or the powder may be taken a tea- 
spoonful at a time, stirred in water. This is the best cure for nearly 
all forms of neuralgia. Applications to the surface, over the seat of 
the pain, often give ease ; apply chloroform and tincture of aconite, 
equal parts, on a cloth, or, for facial neuralgia, rub veratrine oint- 
ment behind the ear, and at the angle of the jaw. Aconitine oint- 
ment may be used in the same way ; or the tincture of belladonna. 
For facial neuralgia use the following : 

Ext. belladonna, 2 grains. 

Make ten pills. Give one pill an hour till the pain is relieved. 



Or this 



Musk, 10 grains. 

Sulphate of quinine, 10 grains. 

Ext. digitalis, 5 grains. 

Make into ten pills. Give two a day. 

This is useful in any form of neuralgia. 



INSANITY. 223 



INSANITY. 



There are two general forms of insanity : one is characterized 
by an unrestrained irritability, which urges on the patient in an ex- 
travagant pursuit of something real or imaginary, to the ruin of 
himself, or annoyance of his friends, and ultimately leads him, if 
opposed in his disordered wishes, to acts of extreme violence. This 
is mania, the common varieties of which are monomania, and simple 
raving madness. 

The other is marked by an unusual depression, sometimes amount- 
ing to despair, a loathing of life, and every thing connected with it, 
accompanied too often by an uncontrollable effort of the patient to 
rescue himself, by his own hand, from his real or imaginary dis- 
tresses. This is melancholia, and sometimes dementia. 

There is a variety of insanity marked by the alternation of these 
two forms in the same cases ; the reaction from a fit of mania run- 
ning into melancholia. 

The passions and emotions most productive of insanity are love, 
fear, fright, rage, ambition, reverse of fortune, and, the greatest of 
all, domestic chagrin, or family dissension. The combination of 
moral and physical causes is much more commonly the origin of 
insanity than either of them singly. The popular notion is that the 
moral causes prevail alone in producing insanity ; but this is an 
error : bodily disease, more or less positive and perceptible, is al- 
ways present, either disease of the brain itself, or disease of some 
organ that by sympathy disorders the brain. The causes of insanity 
do not always act directly on the brain ; frequently, on the con- 
trary, they are preying on some organ at a distance ; the nervous, 
sanguineous, or lymphatic systems, the digestive organs, or the 
organs of generation, being the primary seats of the evil. M. Pinel, 
the distinguished French physician, refers the immediate cause, in 
almost every instance, to a deranged condition of the stomach and 
other digestive organs. It is here he supposes the disease to com- 
mence, and contends that the affection of the brain, and of the 
mental faculties, is subsequent to the symptoms of internal irrita- 
tion, and dependent upon them. This opinion in some degree cor- 
responds with the results of all experience ; we must not, however, 
lose sight of the influence of the relative size and mutual effect of 
particular organs upon one another due to inherited peculiarities. 
Mental derangement, therefore, is mostly a symptom of disease in the 
brain, either slight or severe ; but then that cerebral disease may itself 
be excited only by disease in some other organ, and it will be al- 
ways much influenced by the patient's general health, so that, if the 



224 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

person in whom there is cerebral disease pursues a proper course of 
living, and can have his digestive functions and the secretions of 
other organs brought into and kept in a healthy state, he will 
usually escape insanity. It is a fundamental principle, that the 
brain is the organ of the mind — the mind never manifests itself in 
this world except through the instrumentality of this corporeal 
organ, and therefore the condition of this organ must always influ- 
ence the quality of the mental manifestations. 

The onset of mania is characterized by a manifestation of unusual 
vigor of mind and body, but it is all manifested in a wild, irregular 
way, without adequate cause, a reckless indifference to restraints, 
incessant talking, singing, shouting, obscene language and ges- 
tures ; sometimes excruciating pain, denoted by frequent change of 
postures, beating the forehead, breast, stomach, sides, or belly; 
eructations of wind from the stomach, of a very peculiar fetor ; high- 
colored urine ; delirium. The skin is dry, harsh, and cold, some- 
times with partial, cold, and clammy perspirations ; breath hot and 
offensive ; hurried respiration. If the patient vomits, there may be 
seen in the matter unaltered portions of the food taken several days 
before. 

The symptoms in a well-marked case of melancholy are great 
apathy ; obstinate disposition to dwell upon some mournful topic ; 
sleeplessness, pertinacious silence, and other symptoms of morbid in- 
tensity of thought ; the pupils of the eye dilated, with a peculiar 
dull, muddy look, often employed in a fixed, unmeaning stare or 
vacancy ; general slight nervous thrilling of the muscular powers ; 
anxious solicitude, and importance attached to frivolous inconven- 
iences, especially regarding the sufferer's health ; love of solitude ; 
dread of death. In general, there are well-marked symptoms of 
indigestion, such as pallid complexion, dull eye, languid circula- 
tion, loss of appetite, furred tongue, disturbed and restless nights, 
sometimes attended with fever, debility, frequent sighing. This 
form is seldom seen in the young, unless inherited, or unless it fol- 
lows some debilitating disease, as typhoid fever. 

Treatment. — From the view that all cases of insanity depend 
upon bodily disease, it results that much more can be accomplished 
by treatment in this malady than is popularly thought. Half the 
hopelessly insane cases are made so through default of any curative 
efforts — people -assuming that insanity is an affliction not within 
reach of medical art. Thus cases that might have been readily 
cured in the beginning are left till they induce organic changes, and 
thus become really intractable. At the same time that we declare 
the malady not actually incurable, it must be stated that its treat- 



INSANITY. 225 

ment is one of the highest problems of art, and that "but compara- 
tively little medically is to be done by non-professionals. 

It is always safe to attend to the state of the intestines and di- 
gestive organs. They are never right in these cases, the secretions 
are depraved, and the evacuations sometimes totally neglected. 
Secure a right state of the excretions by small occasional doses of 
calomel, combined with purgative medicine, as 

Calomel, 15 grains. 

Powder of ipecac, 3 grains. 

Jalap, 30 grains. 

Aloes, 6 grains. 

54 grains. 
Mix, and make three powders. 

Give one every other day, and, if one shall prove not efficient, 
give two for a single dose. The insane require larger doses of pur- 
gative -medicines than others. 

It is also always advantageous to stimulate the kidneys in these 
cases, and as these indications are clear, so the benefit that follows 
is evident. Another point of treatment, from which great benefit 
nearly always results, is putting the skin in proper order by use of 
the warm bath. The tranquillizing effect of this agent, moreover, is 
very great. It has more influence in soothing the sleepless cases 
than all the narcotics. Narcotics are seldom effective in inducing 
sleep. Chloroform does better, but is to be used with a sense of its 
danger, and has been given in drachm-doses. Exercise and regu- 
larity in all respects are imperatively necessary. Tonics are proper 
in the large majority of cases, and, whenever the state of the patient 
is known to be the consequence of any disease, that disease or its 
ordinary sequeke in the system must be the objects of treatment. 

With respect to the moral management, it should be impressed 
upon the minds of the friends and relations of the insane that at- 
tempts to reason with them, or to convince them that their halluci- 
nations are the result of mental derangement, will only be abortive, 
and may probably prove hurtful. If a lunatic is not placed in 
an asylum, or otherwise taken from home, he should be separated 
from the rest of the family, and the utmost pains be taken to change 
all his old habits and associations. He should see only new faces ; 
new objects must be presented to him; and every thing that can re- 
call former ideas should be withheld. " The presence of strangers," 
justly remarks M. Esquirol, " suspends the delirium of the insane, 
either by the influence of new impressions, which is always useful, 
or from a secret feeling of self-love, which induces lunatics to con- 



226 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

eeal their state of mind. Patients often appear quite calm before 
their physician and strangers, while they are at the same time 
abusing their relations or friends in an undertone." 

No servant should have the control of a lunatic ; and whoever is 
appointed to that duty should be made fully aware that nothing 
must be done or spoken to excite the ideas and the passions of the 
lunatic upon the subject of his delirium. None of the unreasonable 
ideas or opinions of the lunatic should be directly opposed by argu- 
ment, or discussion, or opposition ; nor should they be contradicted 
or ridiculed. Discussion or opposition only fixes the image more 
firmly, and intensifies the perception. Every means should be taken 
to fix the attention of the lunatic upon objects foreign to the matter 
of his lunacy, and to communicate new impressions to his mind. 
When there is a disposition to suicide, the lunatic must never be 
trusted alone for a single instant. 

When the lunatic is not violent, he should walk out of doors 
twice a day, for an hour or more at a time ; the circulation is thus 
better equalized than by any other kind of exercise. The early 
morning is the best time for the first walk ; the balmy air of the new- 
born day tends to soothe the morbidly-sensitive nervous system, as 
well as to invigorate the habit. Although it is difficult to engage 
the attention of the insane to any particular occupation, yet it 
should always be attempted. Whatever can divert the mind from 
their diseased feelings, tends to break the catenation of symptoms 
which constitutes the disease. 

The attendant on the insane should be firm, but not harsh in his 
manner, and should possess discretion enough never to revert to the 
causes or objects which are supposed to have developed the disease ; 
nor to flatter the exalted ideas which the lunatic often entertains of 
his situation in society. Opposition, contradiction, argument, irri- 
tate and cause them to hate and defy those placed over them. 

Let us say again that recovery is more frequent than is generally 
supposed ; the average proportion may be stated as one in two and 
a half, a fact sufficient to set aside the usual opinion, that a person 
Who is mad must always remain in that state; on the contrary, 
when the disease is not hereditary, nor complicated with other mala- 
dies — and when the insane person is not of advanced age, nor idiotic, 
nor epileptic, nor paralytic — the probability is in favor of recovery. 
The protraction of the disease must not be regarded as positively 
opposing the expectation of this desirable event. M. Baumes has 
recorded the case of " a lady who passed twenty-five years in a state 
of lunacy, within the knowledge of the whole country where she 
lived, and who suddenly recovered her reason." It is, nevertheless, 



DELIRIUM TREMENS. 227 

true that the greater number of recoveries take place at an early 
period of the disease. It is, also, necessary to extend generally the 
knowledge of the fact that the recoveries from madness are fre- 
quently complete. 

DELIRIUM TREMENS. 

There are nervousness ; restlessness and sleeplessness ; trem- 
bling of the hands and limbs ; loss of appetite ; coldness of limbs ; 
feebleness of pulse ; excessive perspiration ; the tongue is furred, 
moist, and tremulous ; there are distressing dreams, excitability of 
temper ; delusions of a horrible nature ; suspiciousness. The pa- 
tient becomes more and more excited and maniacal, and unless 
restrained will do violence to himself or others. 

Intemperance in alcoholic drinks, and opium-eating, are the pre- 
disposing causes. In persons thus predisposed, an attack may be 
excited by any circumstance which depresses the vital powers, such 
as sudden deprivation of the accustomed stimulus ; loss of blood ; 
severe illnesses ; the shock of any severe injury or accident. 

Treatment. — Opium combined with stimulus must be given in 
doses depending on the severity of the attack, the age and strength 
of the patient, and the duration of the habits of intoxication. As 
this is a dangerous medicine, yet is absolutely necessary, we will 
state the greatest quantity which may be safely given by a non-pro- 
fessional person in an extreme case. To a strong-built man about 
forty years of age, with all the symptoms fully developed, give half 
a drachm of laudanum in half a pint of porter, or in a glass of 
spirits. Half these quantities may be repeated every two hours, for 
twelve hours, unless sleep is produced in the mean time. If there 
should be much heat about the head, or general feverishness, a 
quarter of a grain of tartar-emetic may be added to each dose of 
laudanum. In cases where the opium does not procure sleep, the 
only remedy that will quiet the patient is the tincture of digitalis. 
This is as effective as it is perilous ; but there must be less hesita- 
tion in giving it, as in these cases death is imminent. Give it in 
doses of four drachms, to be repeated if necessary. 

When sleep has been obtained, purgatives of calomel with anti- 
spasmodics should be given. Sickness or nausea may be relieved by 
a drop of creosote in a little spirit and water. 

The after-treatment must consist in tonics and the gradual 
diminution or abstraction of stimulants. 

The diet during the attack should be light, but nutritious, such 
as strong beef-tea, broths, etc., with the addition of the accustomed 
stimulus in smaller quantities. 



228 DISEASES OF BRAIN, SPINE, AND NERVOUS SYSTEM. 

DIPSOMANIA, OR THIRST-MADNESS. 

This is characterized by an intense craving for 
liquors, attended by depression and restlessness. It is a disease — 
but a vice also ; and the victim is not an irresponsible creature. 

Bitter tonics and mineral acids, especially sulphuric acid prop- 
erly diluted, must be given. There must be total abstinence from 
alcoholic mixtures, and hyoscyamus must be given to prevent sleep- 
lessness. Begin with two grains, and increase as seems necessary. 



DISEASES MAINLY SYMPTOMATIC OF OTHER 
DISEASES, BUT REQUIRING TREATMENT. 



DROPSY. 

Deopst is a consequence of many diseases. That common form 
m which the abdomen is filled with water is generally the result of 
disease of the liver. In women it may depend upon ovarian disease. 
Dropsy that begins in the feet and legs, though it extend to the 
abdomen, results from disease of the kidney. There can be no way 
to thoroughly and completely cure the dropsy but by curing the 
disease that causes it ; yet, as it is a source of great discomfort to say 
the least, and as the evacuation of the water relieves very greatly, 
it is quite proper to attempt this in the progress of treatment of the 
original disease, or in the absence of other treatment. If the origi- 
nal disease is hopelessly incurable, the evacuation of the water is 
of course the only assistance that can be given. Abdominal dropsy 
in women very likely depends upon ovarian disease. Then the 
only effectual remedy is by tapping, which of course must be done 
by a surgeon or physician. Other dropsies may be treated by med- 
icines, that cause profuse watery . discharges from the bowels, by 
medicines that increase the action of the urinary organs, and by 
sweating. Care must be taken with these not to go too fast, as this 
will weaken the patient and aggravate the original disease. In 
dropsy dependent upon disease of the liver, any of these remedies 
may be used moderately. The best remedy will be : 

Resin of podophyllum, 4 grains. 

Bitartrate of potassa, 3 drachms, 

Mix, and make eight powders. 



230 DISEASES MAINLY SYMPTOMATIC. 

One of these may be taken every two hours till effective. This 
combination will act both on the bowels and the kidney. It should 
not be used, therefore, in those dropsies which began in the feet, for 
these depend upon kidney-disease. In these cases, ' the kidneys 
must have all the rest that is possible, and we must endeavor not 
only to carry off by other channels the accumulated water, but to 
relieve these organs altogether. An effectual medicine- is the 

. Compound powder of jalap, '30 grains. 

This, taken once a day, will give several watery discharges, and the 
doses may be reduced to twenty grains, or increased to forty or 
sixty, according to the effect. Such discharges, kept up for several 
days, will carry out of the system a great deal of water. In severe 
cases, sweating must be resorted to also. 

Liquor ammonise acetatis, or mindererus spirit, is the simplest 
medicine that can be taken for the purpose. A teaspoonful every 
two hours will be sufficient, if the person is kept well covered and 
not exposed to sudden changes of air. In dropsies of heart, chest, 
or brain, the only medicine that can be permanently relied upon is 
the iodide of potassium, which may be taken in quantities varying, 
according to effect, from ten to eighty grains per day, dissolved in 
water. 

There is a dropsy that depends upon an altered state of the 
blood, and is not due to disease of any organ, though it may coincide 
with such disease. It must be treated with iron. Give twenty to 
thirty drops of the tincture of chloride of iron, three or four times 
a day, in water. 



NAUSEA, VOMITING, RETCHING. 

The act of throwing up the contents of the stomach consists of 
a forcible contraction of the muscles of expiration, and of these only, 
the glottis being closed, and the upper orifice of the stomach opened. 
It was thought at one time that vomiting depended upon a convul- 
sive action of the stomach alone ; then came the theory that the 
stomach was passive in the act, which was attributable to the press- 
ure of the muscles of the belly excited to violent action ; but we 
are now quite convinced that both these exciting causes of vomiting 
operate at the same time. 

Although vomiting is generally preceded by nausea, yet this is 
not always the case ; infants frequently relieve their stomachs of an 
over-quantity of food without showing the slightest signs of dis- 
tress, which would not be the case if they felt sick, as well as were 



NAUSEA, VOMITING, RETCHING. 231 

sick, as the phrase generally goes. In the vomiting which not un- 
frequently attends coughing, sobbing, etc., there is also commonly 
an absence of the sensations of nausea. The causes of vomiting 
are numerous : poison, medicines, indigestion, excess of bile, or mu- 
cus, in the stomach or bowels ; a mechanical excitement of the mus- 
cles of the gullet, as with a feather, finger, etc., hiccough, sobbing, 
laughing, the motion of a ship in the water — any thing which is re- 
pugnant and offensive to either of the senses ; mental emotion ; a 
sudden blow or shock to the system. 

The term retching is applied to an ineffectual effort to vomit. 
Violent retching is one of the most distressing symptoms of biliary 
and other derangements of the stomach ; it is sometimes very ob- 
stinate and long-continued, so as completely to exhaust the patient, 
especially if in a weakly state, and cause a rupture of a blood- 
vessel, or other alarming consequences; if it proceeds from an 
overloaded stomach, or the presence of any poisonous substance, 
it is best to produce vomiting by an emetic ; otherwise effervescing 
draughts should be tried, with five drops of laudanum in each. 

The sensation of nausea, the general provocation of both 
vomiting and retching, is usually referred to the stomach, and is 
no doubt commonly due to causes connected with that organ only ; 
yet very frequently the feeling is sympathetic, having its origin in 
the brain or the nervous system ; thus we know that a severe blow 
on the head, a dislocation, or other injury to any part of the body, 
attended with severe pain, will occasion nausea ; so will horrible 
and disgusting sights and sounds, and odors, or any thing which 
affects the brain through the medium of the senses. The nausea 
of pregnancy, too, appears to be purely sympathetic, and the action 
of emetics must be attributed rather to their influence on the ner- 
vous system, than directly on the stomach ; for it has been found 
that they act as well when injected into the veins as when swallowed. 
So we find that gall-stones in the kidneys, tumors in the womb, and 
many other diseased conditions of the various organs, give rise to a 
feeling of sickness — all showing that this feeling is, in many cases, 
merely sympathetic. The relaxed state of the nervous, and conse- 
quently of the muscular system, which attends nausea, is favorable 
to the performance of certain surgical operations, such as the reduc- 
tion of dislocations, ruptures, or constrictions : hence, surgeons, pre- 
vious to such, often produce it artificially by the administration of 
tartar-emetic. 

The proper remedies for nausea, of course, will depend upon the 
causes : if it proceeds from afiection of the brain, but little can be 
done to relieve it ; if from disorder of the stomach, free vomiting, 
16 



232 DISEASES MAINLY SYMPTOMATIC. 

which may be easily excited by warm water and a little ipecacuan- 
ha, or merely tickling the fauces with a feather, or a brisk purgative, 
will afford relief; if occasioned by some nervous shock to the sys- 
tem, a glass of sherry wine or a little brandy, or some other ner- 
vous stimulant. In any case, effervescing draughts made with carbo- 
nate of soda and lemon-juice will be grateful, and probably effect- 
ual; if other means fail, a mustard-plaster to the pit of the stomach 
may be tried ; or creosote, in drop-doses, rubbed down with a little 
sugar or gum ; or a mixture like this : 

Hydrocyanic acid, 12 drops. 

Acetate of morphine, ....... 1 grain. 

Carbonate of soda, 1 drachm. 

Water, 6 ounces. 

Take a tablespoonful every three hours. 

A drop of the above acid, or of creosote in soda-water, is also 
likely to be of service. A reclining position is best for the patient ; 
and perfect quietude, both of body and mind, especially when the 
affection has a nervous origin. 



ABSCESS. 

Heat and tenderness of the part affected are the premonitory 
symptoms of an acute abscess ; it is commonly confined at first to a 
small spot, which becomes red, and painful to the touch: very soon 
a distinct throbbing may be felt, which is a sure indication of the 
formation of matter ; then the part begins to swell, and the skin 
exhibits a shiny, semi-transparent appearance, sometimes being 
tinged with purple ; this becomes more marked and decided as the 
tension increases, with the increase of the matter beneath, until it 
gives way of itself or is opened by some sharp instrument. 

Fomentation with water as hot as it can be borne, and hot bread 
or linseed poultices, should be resorted to in the first stages of an 
acute abscess ; strong drawing and irritating applications are often 
made use of, but this only increases the anguish without doing 
good ; indeed, it is both cruel and hurtful. The poultices should be 
frequently changed, in order to keep up the requisite degree of 
warmth ; they should be carefully adjusted, so as not to press un- 
duly upon the tenderest part, and, when the pain is very severe, 
poppy-heads should be boiled in the water with which they are 
mixed, and this poppy-decoction should also be used for the fomen- 
tations. If, as is often the case, the abscess should be in the hand 
or lower part of the arm, that limb should be supported by a sling 
made of a silk handkerchief, or some other soft material, so as to 



ABSCESS. 233 

keep it from hanging clown ; adjust it so as to have the upper part 
of the arm as nearly perpendicular as may be, and the bend of the 
elbow at right angles with it. To keep the system cool, and allay 
the fever which generally more or less attends active inflammation, 
the patient should take, every other night or so, an aperient pill, 
composed of compound extract of colocynth, four grains ; calomel 
one grain. After the discharge of the thick yellow matter has 
ceased, the poultices may be discontinued, and moist rags kept ap- 
plied for some days, after which the edges of the wound may be 
drawn together by strips of adhesive plaster, over which it is best 
to place a dressing of cerate or spermaceti-ointment. If the wound 
is deep and large, it may be some weeks before it fills by granula- 
tion, but otherwise the healing process proceeds rapidly, unless 
there is a want of vital energy in the system, or a diseased state of 
the part immediately affected ; in this case bad sloughing ulcers re- 
sult, which are very difficult to heal. 

A medical man will generally open an abscess, when it is sufficient- 
ly ripe, rather than wait the slower process of the breaking of the 
skin, and by doing this he often saves the patient much suffering and 
constitutional derangement ; but no person unacquainted with the 
anatomy of the part should attempt this ; to do it effectually the 
cut should be bold and deep, and exactly in the right place ; an un- 
practised hand will probably leave the largest reservoir of matter 
untouched, and so render another incision necessary, and effect no 
good purpose by the pain inflicted. Where the integument which 
covers the seat of the abscess is hard and thick, it is nearly always 
necessary to open it, and only the skilled practitioner can judge 
of the proper time for doing this ; therefore his aid should in all 
such cases be solicited, as in those of deeply-seated and internal ab- 
scesses, which generally assume a chronic character. With regard 
to the treatment of these, no specific directions can be given, it 
must depend much upon the character of the tissues which they af- 
fect ; as a general rule, the patient's strength must be supported 
by a good and generous diet, and the administration of tonic and 
cordial medicines, taking care to keep the bowels moderately open. 
Stimulating plasters made of Burgundy pitch, gum-ammoniac 
with mercury or galbanum, are applied with advantage to the 
abdomen, or other seat of the affection, as are poultices of oatmeal 
with vinegar, or yeast, or water impregnated with salt. For ab- 
scesses in the neck, Astley Cooper recommends incision with a sharp 
knife, pressing the matter well out so as to excite adhesive inflam- 
mation, and dressing the wound with bread-poultices moistened first 
with sulphate of zinc in solution, and afterward with spirits of wine, 



234 DISEASES MAINLY SYMPTOMATIC. 

giving good light nourishment, and carefully regulating the bow- 
els. 

For the relief of the hectic fever, night-sweats, and other con- 
stitutional disturbances, caused both by acute and chronic abscesses, 
but more especially the latter, preparations of bark or iron, min- 
eral acids, or cod-liver oil, may be given during the period of copi- 
ous discharge ; and especially immediately after it, when the powers 
of Nature are most sorely taxed to supply the waste, and reconstruct 
the destroyed tissues, nourishing food and strengthening medicines 
are required. 

HICCOUGH {Hiccup; Hocket). 

This is a convulsive catch of the respiratory muscles and spas- 
modic action of the diaphragm, caused by irritation of the stomach, 
indigestible or unmasticated food ; hysterical laughing ; irritating 
matters in the intestines ; diseases of the organs in the abdomen ; 
pregnancy. 

Treatment. — A draught of cold water ; ether ; antispasmodics, 
as camphor, ammonia ; mustard-plasters on the pit of the stomach. 
One of the most effective and immediate of all remedies is eating a 
lump of sugar. Prevent recurrence by free purgation with alkalies. 

WAKEFULNESS. 

Wakefulness occurs independently of any specific disease being 
present. The best means of obviating it is a tepid bath, taken just 
before bedtime ; but, when this cannot be obtained, the hot foot- 
bath will often answer the same purpose. 

There is a variety of nervous irritation, commonly called 
Fidgets, which always more or less causes wakefulness. It is gen- 
erally accompanied with hot hands and a dry skin, indicative of 
irritative fever. The wakefulness, in this case, is best counteracted 
by placing the hands in cold or in tepid water, for five or ten min- 
utes ; or wrapping the end of a towel dipped in cold water round 
one hand, and allowing the other end to hang over the side of the 
bed. If the weather be mild, nothing so effectually destroys wake- 
fulness as rising from bed, walking about the room for a few min- 
utes, then returning to bed. It is sometimes, also, overcome by sip- 
ping a tumbler of cold water on retiring to rest. 

Sensitive persons, who suffer from wakefulness, should refrain 
from exposing themselves to any causes of excitement for a consid- 
erable time before going to bed. They should not drink coffee, nor 
green tea, at a late hour ; for although these substances do not in- 



NERVOUSNESS. 235 

fluence the circulation to any morbid extent, yet they act on the ner- 
vous system in a manner unfavorable to sleep. Give the bromide 
of potassium in doses of two scruples an hour before bedtime. 



NERVOUSNESS OR IRRITABILITY. 

This is a malady very rife among persons of sedentary habits, 
or those who have exhausted the brain by severe mental labor, or 
weakened the bodily powers by drink and dissipation. The man 
who leads an active, open-air life, and lives temperately, is seldom 
or never the victim of this distressing malady ; nor the active bus- 
tling woman, who does her duty, and meets trials and troubles with 
cheerfulness and courage. Nervous people are peevish and pining, 
having an unsound mind in an unsound body; they have in some 
way violated the laws of health ; generally, but not always, they 
may be the offspring of a sickly and nervous stock, or they may 
have fallen into this state through disease, or some unavoidable 
overtaxing of their bodily or mental powers. In any case they are 
greatly to be pitied, and, if possible, relieved of these distressing 
symptoms, which poison the springs of earthly enjoyment, and make 
life a burden rather than a blessing. Great susceptibility to exter- 
nal influences marks this state of nervousness ; any unwonted sound 
or unusual sight will set the heart palpitating, the head throbbing, 
the hand trembling ; little troubles and difficulties are magnified, 
and mental emotions, of whatsoever kind, seem to overpower the 
mind. The resort in this case is too commonly to alcoholic stimu- 
lants, which, although they may stupefy the senses, and deaden 
the nervous susceptibility for a time, yet produce a corresponding 
depression when the reaction comes on, and render both mind and 
body less capable of struggling against the malady. It is not to 
be denied that these may be employed as remedies in nervous dis- 
eases, and with much advantage, but it is not safe for the patient 
to use them at his own discretion, nor must they be substituted for 
the more permanent means of invigorating the system, such as 
regular open-air exercise, sea-bathing, cheerful society, and strength- 
ening medicines, such as quinine and preparations of iron. Atten- 
tion must be paid to the state of the bowels, as any irregularity 
there will, it is likely, tend to keep up nervous irritability, and coun- 
teract the efforts made for the patient's benefit. If purgatives are 
required, they should be of a warm, stimulating character, such as 
rhubarb with ginger or peppermint. Tincture of valerian and aro- 
matic spirits of ammonia are good nervous stimulants, and should 
be combined with the tonics. 



236 DISEASES MAINLY SYMPTOMATIC. 

NIGHTMAEE. 

This is a nervous affection, in which there is a violent struggle 
and tremor, with a severe pressure on the chest from impeded res- 
piration. The sensation is frequently preceded by some fearful 
dream, as that of an implacable enemy, known or unknown, in 
close pursuit of the dreamer, from whose grasp he feels incapable 
of escaping ; or of exposure to some overwhelming danger. 

It appears most frequently in persons of an irritable or nervous 
temperament, and of a weakly constitution; particularly among 
those who are predisposed to low spirits. Others, indeed, are oc- 
casionally affected by it, but more rarely, and perhaps in a less de- 
gree. The most usual exciting causes are great fatigue of body 
and mind; indigestible food; and long-continued disorder of the 
stomach and bowels. It may often be looked upon as a certain in- 
dication of deranged health. 

Tebatment. — The treatment is very similar to that directed for 
indigestion. The mind and body should be kept free from all un- 
due fatigue and commotion; the diet be light, especially toward 
evening ; and the bowels be preserved regular, by the occasional 
use of cathartic pills. Two grains of quinine and two of sulphate 
of iron, in a pill, twice a day, constitute a valuable remedy. 

If the stomach and general habit are weak, the appetite defi- 
cient, and the pill of quinine and sulphate of iron is not tried, then 
the patient should take carbonate-of-iron pills, with very considerable 
daily exercise. In all cases, the supper must be very simple, and 
small in quantity, animal food being then altogether avoided. 

VARICOSE VEINS. 

Varicose veins are not uncommon in the legs of stout elderly fe- 
males, and may be met with in those of all ages, and both sexes. 
In this affection there is enlargement of the vessels, which stand out 
from the surface of the limb, like cords, like which, too, they often 
assume a knotted appearance. This affection may be attributed to ob- 
literation or deficient action of the valves of the veins of the leg, or 
some other cause of obstruction of the flow of blood upward, through 
those of the abdomen. Pregnancy, habitual costiveness, liver dis- 
ease, abdominal tumors, may be all mentioned as exciting causes. 
The pressure of a truss, or belt also, or of garters too tightly tied, 
may bring on this varicose condition of the veins, especially in 
persons whose occupation necessitates much standing. Great care 
should be taken to avoid a scratch or contusion of the swollen 
part, or a wound may be produced which is likely to result in an 









HEADACHE. 237 

ulcer very difficult to heal. The part should he supported and 
protected hy a bandage, or elastic stocking ; if the former, it should 
be very carefully and evenly applied, hut a well-fitting stocking of 
elastic web is the best and most convenient. 



FETID PURULENT DISCHARGES FROM THE EAR. 

Purulent discharges from the ear frequently follow severe cases of 
scarlet fever, and some other eruptive diseases, and continue for the 
rest of life. But, although this discharge cannot always be checked, 
yet it may be moderated, and the fetor corrected, and in this respect 
it becomes an object of domestic management. The ear should be, 
every morning, syringed with either tepid water, or tepid lime- 
water ; and, immediately afterward, two or three minims of a mix- 
ture, composed of two drachms of balsam of Peru and six drachms 
of fresh bullock's gall, well mixed together, should be dropped 
into it. Cotton or wool, moistened with glycerine, ought to be 
worn in the ear, to absorb the discharge, and to prevent the injuri- 
ous influence of cold. Give quinine freely and constantly. 



HEADACHE 

Is usually a symptom of some disorder of the brain, nervous sys- 
tem, or digestive organs. It presents great varieties of character, 
depending upon its causes. 

1. Seadache from congestion, or over-fulness of the vessels of 
the brain, occurs from those causes which impede or increase the cir- 
culation through the brain — as the use of narcotics, intemperance, 
prolonged or excessive mental exertion, fevers, irregular or sup- 
pressed menstruation, exposure to the sun, etc. The pain is of a 
deep-seated, heavy character, throbbing, with noises in the ears, 
giddiness, fulness of the eyes. 

2. Nervous headache arises from any moral or physical agency 
by which the vital powers are depressed. The pain often comes on 
suddenly, and is very acute and darting, attended with giddiness 
and nervous agitation ; the head cool and face pallid. The pulse is 
feeble. There is no febrile disturbance. This form is very generally 
worse in the morning than in the evening. It oftens assumes an in- 
termittent type. Hysterical persons are liable to this form of headache. 

3. The bilious or sick headache is attended with nausea or vomit- 
ing, heart-burn, and other evident signs of disordered stomach or 
liver. The pain is very acute or heavy, often confined to one side 
of the head, or moving from one part to another. This variety is 



238 DISEASES MAINLY SYMPTOMATIC. 

caused by errors of diet, by intemperance, by excessive mental ex- 
ertion, and moral excitements ; by derangements of the stomach, 
costiveness, etc. This form of headache is frequently associated 
with hypochondriasis. 

4. Rheumatic headache, accompanies catarrh, and may generally 
be found to be external, as indicated by its being increased by 
movement, by the character of the pain, by the tenderness of the 
surface, by the presence of symptoms of rheumatism in other parts 
of the body, and by its having been caused by cold. 

5. Headaches from Organic Affections of the Brain. — These may 
be distinguished from the preceding by their being more constant 
and prolonged, by the frequent occurrence of retching, or by the 
presence of convulsive or paralytic affections. 

The headache dependent upon derangement of the stomach, in- 
digestion, etc., and that dependent on congestion of the head, in 
which there may or may not be derangement of the bowels, are 
the commoner varieties. The immediate attack of each is soon re- 
lieved by a cathartic dose : 

Compound powder of jalap, . . . . . 20 grains. 

Powder of rhubarb, 10 grains. 

As soon as this acts, the pain will be relieved; but its action 
may be hurried by taking two or three cups of warm tea. Let the 
patient, at the same time, sit with the feet in a pail of hot water. 
The recurrence of the attacks is to be prevented by attention to 
diet, exercise, and bathing, and the use of iron and bitters, as gen- 
tian. 

The rheumatic headache and brow-ague will give way only to 
quinine ; but the application of wet compresses, applied as hot as 
they can be endured, will relieve the pain. The nervous headache 
will also be relieved in most persons by hot water. In others, cold 
is more effective ; try both — for this headache use the following : 

Atropia, 1 grain. 

Water, . • 2£ ounces. 

Sulphuric acid sufficient to make a solution ; take from 10 to 20 drops. 

All who are " subject to headache " should habituate themselves 
to the use of the shower-bath. 



HAEMORRHAGES (spitting Blood— Hemoptysis). 

With, or it may be without cough, blood is expectorated in greater 
or less quantity. Sometimes the expectoration of blood is pre- 
ceded merely by a sense of tickling in the throat. The blood may 



HEMORRHAGES. 239 

be in such large quantity as to constitute the whole of the expecto- 
ration, or it may merely tinge or streak the phlegm that is coughed 
up. If in a considerable quantity, a sense of suffocation may be ex- 
perienced, or vomiting may be excited. The appearance of blood 
in this manner excites alarm, and produces acceleration of the 
pulse. The color of the blood is generally florid, and, from ad- 
mixture with air, it may be frothy. 

These symptoms may recur. The intervals are uncertain. 
Sometimes the first attack is so profuse as to prove fatal. 

Causes. — Consumptive disease in the lungs ; inflammation of 
the lungs ; deformities of the chest ; disease of the heart ; certain 
trades ; external injury to the bones of the chest ; over-exertion in 
lifting weights, etc. ; tight lacing ; suppression of accustomed dis- 
charges ; violent mental emotions ; sudden surprise ; severe fits of 
coughing or sneezing. 

Distinctive Symptoms. — It may be difficult to say with certainty 
whether blood have come from the lungs, stomach, throat, or the 
nose. In the latter case, the fluid is ejected from the nostrils as 
well as from the throat ; it has not a frothy character. If ejected 
from the stomach, it is usually dark-colored, not frothy, and is at- 
tended by sickness and vomiting. 

Teeatmext. — The strictest rest, silence, and freedom from men- 
tal agitation, are of the first importance. The patient should be 
placed in a half-sitting posture. Cool air must be freely admitted ; 
all superfluous bed-hangings, or overcrowding of the apartment, 
must be avoided. The occurrence of spitting of blood is one of 
the earliest signs of the existence of tubercles in the lungs (con- 
sumption), and is, to a certain extent, a natural relief to congestion 
in those organs. It is not necessary, therefore, suddenly to arrest 
the bleeding. 

As congestion is most commonly the exciting cause, the removal 
of blood from between the shoulders, or the hollow of the throat 
just above the breast-bone, is one of the remedial means to be em- 
ployed. Leeches, or the cupping-apparatus, will be the proper 
agents for this purpose. Dr. Graves says that " no topical bleeding 
appears to me so useful as the oozing of blood from that situation 
where the cough is teasing, and haemoptysis considerable ; six leech- 
es should be applied every six hours, or in less severe cases a 
smaller number, and at more distant intervals." 

Spare diet and perfect quiet are among the other most useful 
measures to be adopted. The bowels should be freely opened 
by means of a saline purgative, preceded, where they are costive, 
by from three to five grains of calomel, and assisted by an enema 



24:0 DISEASES MAINLY SYMPTOMATIC. 

of salt and gruel ; if the bleeding continues, two grains of powder 
of ipecacuanha should be administered every quarter of an hour 
until it abates ; the chest also should be sponged with vinegar and 
cold water, and a dessertspoonful of the former in half a wineglass- 
ful of the latter will be a useful accompaniment to any other medi- 
cines which may be thought necessary. The remedies will vary 
considerably in accordance with the peculiarities of the case ; some- 
times mineral acids, such as the dilute sulphuric, from fifteen to 
twenty drops in cold water, three or four times a day ; in some cases 
ten or fifteen drops of spirits of turpentine may be given ; and as a 
ready remedy, when no other is to be obtained, common salt, a tea- 
spoonful at the time, repeated frequently. To get up the strength 
after an attack of this kind, nutritious diet, with preparations of 
iron, or bitter tonics, and mineral acids. Persons subject to hae- 
moptysis, from whatever cause, should live abstemiously, avoid 
late hours, exposure to cold or great heat, and excitement of any 
kind. In habitual and protracted cases, change of climate may be 
necessary. 

VOMITING BLOOD (Hcematemesis). 

Vomiting of blood is a discharge of blood from the stomach, 
and is generally preceded by affections of that organ and of struc- 
tures in its neighborhood. There is often pain or uneasiness 
of the left side, with anxiety, and a sense of tightness in the chest. 
The blood discharged is generally dark-colored, grumous, and often 
mixed with some of the contents of the stomach. It may occur in 
persons of a full habit and robust constitution, but is most common 
in those who are weakly, or who labor under a faulty condition of 
the blood and obstruction in the liver. 

Whatever greatly deranges the functions of the stomach, or 
produces bad blood and internal obstruction, may give rise to it ; 
and the most frequent causes appear to be grief, or other depressing 
or violent passions ; costiveness, especially if occurring in a consti- 
tution in which the stomach is peculiarly irritable ; blows on the 
region of the organ affected ; fulness of habit combined with, an in- 
temperate mode of life. It is generally a symptom of something 
wrong in the general system. 

It is, in general, easily distinguished from spitting of blood, 
by the bloocl being here brought up by vomiting, and by its being 
of a deep modena color. It is also generally mixed with some of 
the contents of the stomach. In spitting of blood, on the contrary, 
the fluid discharged from the lungs is brought up by hawking, or 
coughing, and is of a bright-red color. 



BLEEDING FROM THE NOSE. 241 

Treatment. — The first general object of treatment in simple dis- 
charge of blood from the stomach is to open the bowels freely with 
a saline cathartic. Use the following : 

Cream of tartar, 2 scruples. 

Sulphate of potash, 2 scruples. 

Nitrate of potash, 6 grains. 

Camphor, 3 grains. 

Mix, and take in water, and repeat it in the course of a couple of 
hours, two or three times, until it acts on the bowels, which it will 
do mildly and effectually. This powder should be continued about 
twice a day for the first three or four days, and after that every 
morning, taken in cold water. In all discharges of blood, saline 
remedies are of the first importance. They relieve congestion in 
the circulation of the liver, unload the bowels, promote healthy se- 
cretions, and improve the quality of the blood. 

Should the discharge prove obstinate, give ten grains of powder 
krameria in water. After the discharge of blood has been checked 
by these means, the use of tonic pills of sulphate of quinine, or an 
iron mixture, should be entered upon. These should be taken thrice 
a day, until the blood is improved, and the stomach and general sys- 
tem have recovered that degree of tone which will pretty certainly 
secure the patient against the recurrence of the vomiting. 

BLEEDING FROM THE NOSE (Epistaxis). 

Persons of a sanguine temperament, and full habit of body, are 
most subject to this disorder, which in many cases should be re- 
garded as a salutary provision for the relief of the overcharged sys- 
tem. If it does not run to a weakening extent, it is very question- 
able whether it should be interfered with. Those who are troubled 
with vertigo and headache, arising from a fulness of the veins and 
a tendency of blood to the head, know how much better and 
lighter they feel after a good bleeding from the nose ; and there 
can be no doubt that many a fit of apoplexy has been averted by 
it, and many an attack of inflammatory fever, or inflammation of 
the brain. This bleeding may arise from several causes, among 
which may be named violent exercise, great heat, blows on the part, 
the long maintenance of a stooping posture, and a peculiar small- 
ness of the vessels which convey the blood to the brain, rendering 
them liable to rupture ; it may come on without any previous warn- 
ing, or be preceded by headache and a sense of heaviness, singing 
noises in the ear, heat and itching of the nostrils, throbbing of the 
temporal artery, and accelerated pulse. When it comes on too fre- 



242 DISEASES MAINLY SYMPTOMATIC. 

quently and continues long, so as to cause faintness, and especially 
if the person subject to it be of a weakly habit or advanced in 
years, it should be stopped as soon as -possible. The stoppage may 
sometimes be effected by immersing the head in cold water, free ex- 
posure to cool air, and drinking cool acidulous liquids ; the body 
of the patient should maintain an erect position, with the head 
thrown somewhat back, a key or other cold substance be applied to 
the spinal cord, vinegar be snuffed up the nostrils, or an astringent 
wash injected with a syringe; it may be composed as follows : 

Alum and acetic acid, of each 2 drachms. 

Water, • . .6 ounces. 

Or three drachms of the muriated tincture of iron in the same 
quantity of water ; or, if these fail, the nostrils may be plugged 
with lint dipped in a strong solution of the sulphate of copper ; or 
the lint first moistened, and then dipped in finely-powdered char- 
coal. When the bleeding has stopped, there should be no haste to 
remove the clotted blood from the nostrils ; let it come away of 
itself; do not blow the nose violently, nor take stimulants, unless 
there be excessive faintness, in which case a little cold brandy-and- 
water may be taken. When there is a full habit of body, cooling 
medicines, low diet, and leeches to the temples, may be safely ad- 
vised, with a purgative dose of calomel. 

DISCHARGE OF BLOOD FROM THE BLADDER {Hematuria). 

The chief causes of this discharge of blood are — a stone in the 
bladder; a violent blow on the kidneys or bladder; or general 
weakness and indisposition. It is frequently dependent upon debil- 
ity, and the most efficacious remedies are the superacetate of lead, 
gallic acid, and the tincture of muriate of iron. Twenty or thirty 
drops of the tincture of muriate of iron may be taken in water every 
hour, or every second hour, till the bleeding stops. Whatever are 
the medicines resorted to, the compound powder of ipecacuanha 
may be given with great advantage at the same time, to allay pain 
and irritation. Three or four grains made into a pill with extract 
of hemlock, three times a day, is the proper dose. The use of mu- 
cilaginous drinks will likewise be very proper, as a strong solution 
of gum-arabic in water, linseed-tea, or decoction of marshmallows. 

Gallic acid is a remedy of extraordinary value in the treatment 
of hematuria, or bleeding from the bladder. It should be given in 
doses of five or six grains in a draught, with an ounce and a half of 
mucilage of gum-arabic, and ten drops of tincture of henbane, which 
draught is to be repeated at short intervals. 



TOOTHACHE. 243 



TOOTHACHE. 



For this distressing and very common malady almost every one 
has a " sure cure," the peculiarity of which is, that it does little or 
nothing to mitigate the anguish of the sufferer. The pain is com- 
monly caused by the exposure of the interior pulp, containing the 
nerve and blood-vessels, to external influence, by decay of the outer 
portion of the tooth. Among the remedies pretty generally suc- 
cessful are, creosote, chloroform, and laudanum, separately or in 
combination ; they may be tried all ways : the mode of application 
is to saturate a small piece of lint or wadding, and introduce it into 
the hollow of the tooth, keeping it there as long as may be neces- 
sary ; should there be no available hollow, put it as close as possi- 
ble to the seat of pain. Other remedies are — applying a drop or 
two of the oil of cloves, or cinnamon, on lint ; or thrusting into the 
hollow tooth a piece of wire previously dipped in strong nitric 
acid ; this application, if properly made, destroys the nerve, but it 
must be very carefully done, so that the acid does not touch the 
other teeth or the mouth. An aching tooth may oftentimes be 
plugged, and remain serviceable for years. Where a tooth is so 
far gone as to be very troublesome, it is best to have it out ; the 
pain of the operation is sharp, but short, while the constant ache, 
ache, ache, destroys alike health and spirits, and unfits one for all 
the active duties of life. 

Where the teeth ache without a perceptible cavity in any one, 
and the aching is not confined to a single tooth, it is a form of 
neuralgia. Give the carbonate of iron freely. Valet's mass is a 
convenient form. From five to twenty grains a day may be taken 
for several days. 

The extract of belladonna, one-fourth of a grain, once in four or 
five hours through a day, for an adult, is often most effective. 

The teeth should be kept clean. Their aching depends upon 
decay as a rule, and decay depends upon two sources of impurity. 
The first is a deposit of tartar upon them near the gum ; and the 
second is portions of food adhering to them after meals. The 
accumulation of tartar is a frequent source of disease in the teeth 
and gums, and precautions should be taken to prevent its adherence 
to them. The best plan is that of cleaning them with the brush 
night and morning. Dentifrices are frequently employed, and, 
perhaps, when simple, they are of service. All chemical products, 
however, should be avoided. Any thing which acts chemically upon 
the tooth will open the way to speedy decay. The simplest denti- 
frice, and one of the best, is a mixture of prepared chalk and well- 



244 DISEASES MAINLY SYMPTOMATIC. 

powdered camphor. The chalk acts as a scouring material, while 
the camphdr stimulates the gums, and counteracts the decomposi- 
tion of any small particles of food that may lurk among the teeth. 
The purer the water that is employed for washing the teeth the 
better. 

To cleanse away portions of food adhering to the teeth, the 
toothpick should be used. Metallic toothpicks are objectionable ; 
those made of bone or quills are to be preferred. 

"When teeth are found to be decayed, immediate attention should 
be paid to them. They more frequently indicate serious derange- 
ment of the health than is imagined. Where teeth are already 
decayed, they cannot be restored to their pristine integrity, but the 
decayed part may be removed, or the whole tooth may be extracted. 
The sooner this is done the better; for decay has an undoubted 
tendency to spread, and nothing is so disagreeable to other people 
as the breath of a person tainted with the faint odor of decomposing 
teeth. * 

Gum-boils are little abscesses, generally the result of disturbance 
at the root of the teeth. Hasten their suppuration by applications 
as nearly like poultices as possible. The best is a split fig. 

COMMON COLD. 

No disorders of the system are more common, in this climate, 
than those originating in sudden changes of temperature. Any sud- 
den variation in the weather, or failure to adapt ourselves to it, 
starts a train of evils in every family. One member has a cold 
" in the head," another has it " on the chest," a third has deranged 
bowels, a fourth an earache, a fifth a neuralgic face, a sixth is con- 
scious again of the old rheumatism, and so on — innumerable ills due 
to trouble with the several functions,. dependent on changed relation 
with regard to cold and heat. 

Catching cold is " catching heat." It is not the exposure to the 
cold so much that does the harm, as the indiscreet way in which we 
warm ourselves after exposure. The haste we make to be comfort- 
able is the general origin of the trouble. . "We get cold gradually, 
and we try to get warm at once, and do get warm in certain parts, 
perhaps, but we thus establish an inequality of heat in the system. 
One part is hot while the other is still cold, and thus the circulation 
becomes disordered, and the functions are disordered with it, 
through the congestions thus set up. It is the same in taking cold 
by sitting in a draught — we establish an inequality of temperature 
for different parts of the system. 



COMMON COLD. 245 

The proper plan, therefore, is to restore the lost heat gradually ; 
make the reaction of the system from the cold natural, and it will be 
general ; stimulate with sudden heat, and it will be partial. 

When you come out of a very cold atmosphere, you should not 
at first go into a room that has a fire in it, or, if you cannot avoid 
that, you should keep for a considerable time at as great a distance 
as possible, and refrain from taking warm or strong liquors. This 
rule is founded upon the same principle as the treatment of any 
part of the body when frost-bitten. If it were brought to the 
fire, it would soon mortify, whereas, if rubbed with snow, no bad 
consequences follow from it. Hence, if the following rule were 
strictly observed, when the whole body, or any part of it, is chilled, 
bring it to its natural feeling and warmth by degrees, the frequent 
colds we experience in winter would, in a great measure, be pre- 
vented. 

The treatment, when the cold is taken, should be repose in a 
moderately warm atmosphere, the use of diluting drinks, barley- 
water, or gruel lukewarm, and an aperient, or ten grains of blue-pill. 
If the cold be more severe, add active diaphoretics, as the liquor of 
acetate of ammonia, and keep in bed. 

If the snuffles and running at the nose are troublesome, throw a 
few drops of tincture of iodine into warm water, and inhale the vapor, 
or take the carbonate-of-iron pills. This is generally the first con- 
sequence of cold, and as it passes away a cough follows, the trouble 
going downward from head to chest. While the cough is dry, the 
best medicine for it is Dover's powder, taken on going to bed, from 
five to ten grains. If the cough is moist, use the following pill : 

Compound squill-pill, ■£ drachm. 

Powder of ipecac, 15 grains. 

Extract hyoscyamus, 15 grains. 

Make thirty pills ; take one or two for a dose. 

The weakly and delicate, who are subject to frequent colds, 
should endeavor, by diet, regimen, daily sponging with cold water, 
and medicine, to invigorate the general habit, remembering that the 
most effectual way of guarding against cold is by raising the sys- 
tem above the influence of ordinary change through increasing its 
strength. 

In nearly all persons, if a cold lingers, and becomes chronic, 
tonics are proper ; and the sulphate of quinine, two or three grains 
a day, or the carbonate of iron, four to six grains a day, is the 
best. 



246 DISEASES MAINLY SYMPTOMATIC. 



COUGH. 

Cough indicates disorder of the respiratory organs, or irritation 
of their nerves. It arises whenever the air irritates the passages 
naturally fitted to receive it, and is the effort of the organ to expel 
the cause of irritation. 

Cough is present in bronchitis, whether the simple bronchitis of 
common cold, or the acute or chronic graver inflammation ; in pneu- 
monia ; in pleurisy ; in all diseases of the larynx, and of the throat 
in croup ; where there are worms in the intestinal canal ; in asthma ; 
in whooping-cough ; in heart-disease ; in hysteria ; in tubercles. 

In pneumonia, pleurisy, or tubercles, there will always be other 
associated facts to distinguish it, particularly pain in the breast. 
In asthma, hysteria, and in whooping-cough, the cough occurs in 
paroxysms that seem to threaten suffocation ; in the larynx it is al- 
ways harsh, and affects the voice ; in croup it is barking ; and that 
from heart-disease is always accompanied with a peculiar uneasiness 
and anxiety. 

We need hardly say that it is in vain to take cough-mixtures 
with a view to curing these several forms of cough ; the only cough 
for which these preparations are at all useful is that due to the dis- 
order and irritation left behind by a common cold ; a good medicine 
for this is the pill recommended under common cold ; but the regu- 
lar use, for some days, of the sulphate of quinine is better than all 
else. 



DISEASES OF BONE AND TENDONS, AND 
DEFOEMITIES. 



INFLAMMATION OF BONE, CARIES AND NECROSIS. 

Severe and deep-seated pain, with swelling of a limb, most com- 
monly of the thigh or leg of children, generally indicates an acute in- 
flammation of the bone. There is usually great constitutional dis- 
turbance, shown by active fever, shivering, etc. After a few days 
the skin of the limb at some part begins to have an inflamed ap- 
pearance, and in a day or two more it will be felt soft and baggy, 
and matter forming will point somewhere on the surface. 

The causes of this are cold, bruises, sprains, and constitutional 
diseases of a scrofulous character. 

There is a chronic form that may follow the acute, and another 
that may be original in itself, lasting through years. This originally 
chronic form is commonly dependent upon syphilis, though it may 
also depend upon other diseases. In the other, after the acute symp- 
toms have subsided, a slow inflammation is left, accompanied with 
continued discharge of matter, indicating abscess of the bone, or 
the death of portions of it — necrosis or caries. Sometimes the 
entire shaft of a bone dies, and is only to be separated by a difficult 
surgical operation. Small portions of dead bone presenting at the 
surface may be removed by a pair of forceps. 

Treat the disease in its acute state by active leeching ; warm- 
water dressing, the limb being elevated in a position on a line with 
or above the line of the body, active purging, and saline fever-medi- 
cines. When matter points at the surface, an opening for its exit 
should be made at the most depending part. 

There is no more distressing malady in the whole range of ills 
that flesh is heir to than chronic inflammation of the bone. Rest is 
the most important point in the treatment, and soothing the noctur- 
17 



248 DISESAES OF BONE AND TENDONS, AND DEFORMITIES. 

nal pain by opiates. Give iodide of potassium, with tincture of 
cinchona ; tincture of iodine applied locally, if the skin be not in- 
flamed or broken, the limb being rested and supported by band- 
aging. The state of the health should be improved by change 
of air, with tonics and a good diet. One of the best tonics for 
these cases is iodide of iron. 

RICKETS. 

This is a softening of the bones from want of earthy matters, due 
to debility. The name rickets is applied exclusively to the disease 
as it occurs in children ; but it occurs in grown persons also, and is 
then called osteomalacia. 

The symptoms are — indisposition or inability for exertion ; im- 
paired or capricious appetite ; irregular or disordered bowels ; soft, 
flabby flesh ; profuse perspiration ; emaciation. After these symp- 
toms have lasted for several months, a disproportion becomes appar- 
ent between the size of the head and of the body ; the abdomen 
becomes enlarged ; the bones of the arms and legs are observed to 
be bent, and their extremities enlarged, swollen, or knobby. This 
state may remain for years, and never get worse ; or the softening 
and deformity of the bones increase so much that it is not possible 
for the sufferer to sit erect, and the organs within the body become 
so encroached upon and interfered with, that they can no longer 
perform their functions. 

The treatment for a child is a healthy wet-nurse ; pure fresh air ; 
attention to the state of the bowels, etc. And, in addition to this, 
for a child and for an adult, sea-bathing ; sponging and friction of 
the body and limbs; mineral acids and other tonics internally. 
Good, nutritious diet ; earthy matters, as lime-water and magnesia, 
to be given as often as possible in the food. 



HIP-JOINT DISEASE. 

Hip-disease prevails in cold, moist climates, and attacks chiefly 
children between the ages of seven and fourteen, though it is not 
unfrequently met with both before and after that time of life. The 
first symptom complained of is generally pain in the knee, which 
often exists for months before any indications can be perceived of 
the true seat of the disease. Sooner or later the patient is observed 
to walk awkwardly and less vigorously than usual ; and, when the 
circumstances on which the difference depends are investigated, it 
appears that the affected limb is elongated and emaciated; that 
the convexity of the hip is flattened, so that the furrow between it 



SPINAL CURVATURE. 249 

• 

and the thigh is less distinct and more oblique in its direction, and 
that, in standing, the foot is advanced a little before the other one, 
with the toe slightly turned out ; and that the patient does not rest 
his weight upon it. Pain is now felt in the hip-joint itself, and, 
though aggravated by motion, often becomes more severe from 
time to time, without any such cause of irritation. It is most apt to 
do so during the night, particularly when the weather is wet and 
changeable. In the second stage, the disease generally remains 
several months, and, sometimes, a year or two. At length, the 
symptoms which have been mentioned either disappear, and the 
limb recovers its former condition, or they are succeeded by others 
still more disagreeable. In the latter case, the limb becomes con- 
siderably shorter than the sound one ; its mobility, at the same 
time, being much impaired, or altogether destroyed, and permanent 
rotation, either inward, or outward, also taking place. Collections 
of matter now make their appearance, most frequently in the outer 
wall of the hip, but occasionally in the groin and hip. In some few 
instances, but very rarely, the fluid of these abscesses is absorbed, 
but the ordinary course which it follows is to issue externally 
through openings formed by ulceration, or artificially by surgeons. 
The patient then, after a tedious illness, becomes hectic and dies, or 
recovers with a stiff joint, and wasted, useless limb. 

As this disease is generally pretty far advanced before it is dis- 
covered, but little can be done for it in the way of domestic treatment. 
As a general rule, counter-irritants in the first stages, such as blisters 
and setons, with a leech or two, if the swelling and inflammation 
accompanied with pain are great, will give some relief; but, for cure, 
the only plan is to give absolute rest to the joint, and sustain the 
system by tonics. Put the limb in a splint, the points of support 
being taken from the body so as to prevent motion; then, by 
weights to the foot and adhesive straps along the limb, cause such 
tension as will keep the head of the thigh-bone drawn away from 
its socket. This gives the inflamed surface of the joint a chance 
to heal. 

SPINAL 'CURVATURE. 

There are three varieties — lateral curvature, anterior curvature, 
and posterior curvature. The first variety, in which the spine is 
bent to the side, generally the right side, occurs more frequently 
than the others, and is the least serious. Posterior curvature is the 
bulging outward of the spine in the upper part of the back, making 
the subject what is called round-shouldered ; and anterior curvature, 
(Pott's disease) is the bending inward toward the body of the spine, 



250 DISESAES OF BONE AND TENDONS, AND DEFORMITIES. 

through actual disease and destruction of the solid portion of the 
vertebral bones. This last is perhaps the only true disease of the 
spine, the other forms of curvature depending upon destruction oi 
the balance of parts, and loss of the relation of the spine through 
undue development of one side or the other, or debility of the 
tendons and muscles. 

In lateral curvature, the first circumstance that attracts atten- 
tion is one breast appearing larger than the other, or so changed 
as to lead to a suspicion that it is growing out of its' place ; or the 
patient's friends note that the right shoulder appears enlarged, and 
farther removed from the spine than the left. At the same time 
there is generally an apparent enlargement of the left hip ; so that 
the ordinary visible effects of the lateral distortion are, such a change 
in the appearance of the right shoulder, and hip on the opposite 
side, that mothers, in describing the state of their child, when the 
spine begins to be distorted, explain it as a growing out of the right 
shoulder and of the left hip. In this condition, the patient, when in 
certain positions, appears to have one leg shorter than the other ; 
and, in walking, there is a constrained position of the head and neck, 
and inclination to one side, and also an inequality in the step. If, 
when these appearances present themselves, the spine be examined, 
it will be found nearly in the form of an italic /, and perhaps with a 
slight bend outward ; and the whole of the right side will be of a 
rounded or barrel-like form, while the left is diminished and con- 
tracted, the ribs being closer together than is natural. 

The immediate cause of the lateral curvature is debility, how- 
ever induced, and affecting more especially the muscles and liga- 
ments of the back. This debility may be induced by the want of 
sufficient general exercise, and especially of that which acts more 
"immediately on the muscles of the back — by sitting long at work, 
or in practising on a musical instrument without artificial support — 
by a habit of lounging on one leg — by indulging much in sleep on a 
soft bed with a high pillow — by the fashionable but pernicious at- 
tempts that are made to correct the figure, or to model it into a 
certain form. This disease occurs most among young girls. 

In the anterior curvature the spine is bent, so as to form an 
angle. In most cases of this kind of disease in the spine, the lower 
limbs are sooner or later affected with some loss of the power of 
voluntary motion, and ultimately with complete paralysis. Indeed, 
on minute inquiry, it is found that languor, listlessness, unwilling- 
ness to move, and unsteadiness in motion, have preceded the visible 
disease of the spine in a greater or less degree. This is a disease of 
scrofulous children. 



SPINAL CURVATURE. 251 

In the treatment of lateral curvature, proper rest is of much 
consequence, but it must not be rest that fatigues, not prolonged, 
restrained, continual rest, as on the sofa made for these cases ; but 
such rest as will render it impossible for the weak parts to suffer 
from the effects of exhaustion and languor, and the spine, in conse- 
quence, to become more distorted. Occasional ease and rest should, 
consequently, be given to the muscles of the spine by the patient's 
lying down, either on an inclined plane, or on a couch, and this she 
should do whenever she feels fatigued, or a want of such rest. To 
confine young ladies to the inclined plane, or to the couch for 
months together, often without their being allowed to rise during 
any part of the day, has been considered sufficient to cure the dis- 
tortion ; but the practice is extremely irrational and injurious, and 
should never be followed in lateral curvature. It invariably injures 
the general health, and, by augmenting the debility of the muscles 
of the back, and whole constitution, increases the curvature, and 
sometimes induces additional complaints of a serious nature. Proper 
exercise, giving up the habit or occupation that induced the trouble, 
and nutritious diet, will suffice for the cure. By proper exercise in 
these cases we mean only such as will excite vital action in the parts 
involved — as in the annexed table. 

Table of gymnastic exercises for spinal curvature, by which the 
reader will perceive the slow and gradual manner in which pa- 
tients, in such cases, proceed from slight exercise to those which 
require greater strength and exertion. 

1. To make prolonged inspirations, sitting. 2. Prolonged in- 
spirations, the patient standing, the arms fixed. 3. The same exer- 
cise, the arms hanging down. 4. The same, the arms extending 
horizontally. 5. The same, the arms fixed to a horizontal pole. 6. 
Deep inspiration, and counting a certain number without drawing 
the breath. 7. Movement of the feet on the ground, the patient sit- 
ting. 8. Deep inspiration, the patient lying on the left side, and 
leaning on the elbow. 9. In the same position to raise and to lower 
the body. 10. Walking slowly, and making deep inspirations. 11. 
Walking a little faster, and counting several steps without drawing 
breath. 12. Bending without rising, the weak hand fixed above. 
13. Beating time with both hands fixed to the horizontal pole. 14, 
15. Beating time, bearing a weight in the weak hand. 16, 17. Lift- 
ing up a small box from the ground with both hands, and then with 
the weak hand. 18, 19, 20. To declaim without moving, and to 
sing without drawing breath. 21, 22, 23. Movements of balance 
simple, in front and on one side. 25, 26, 27, 28. Develop other 



252 DISEASES OF BONE AND TENDONS, AND DEFORMITIES. 

motions of the arms, and to imitate the motion of sawing. 29, 30. 
These exercises with the weak hand only. 31, 32. To draw upon a 
spring with the weak hand only, and then with the arms and body 
fixed. 33. Seated on the ground, to rise with the assistance of the 
arms, the feet fixed. 34. Lying down horizontally, to raise the 
body without the assistance of the arms. Other exertions, of a 
similar kind, may follow these. . 

Posterior curvature may generally be remedied by position and 
the use of stays. It occurs mostly in near-sighted persons. 

Anterior curvature must be treated as a true scrofulous disease, 
by cod-liver oil, iodine, iron, good diet, and pure air. Some deform- 
ity is inevitable. 

SPRAIN. 

This consists in stretching or tearing the ligaments of a joint. 
It is an accident that most frequently happens to the parts near the 
wrist and ankle. It causes extreme pain, sometimes faintness and 
vomiting. There is, generally, effusion of blood beneath the enlarge- 
ments, hence the discoloration observable in these cases ; commonly, 
also, there is rapid swelling, which renders it difficult to ascertain 
whether a dislocation or fracture has not taken place. Not only 
are sprains excessively painful at the time of their occurrence, but 
they are likely to lead to permanent injury, especially if neglected, 
and in this case they are more difficult to cure than either disloca- 
tions or fractures. It would be better to break a limb than sprain 
a joint, the former, in ninety-nine cases out of a hundred, being cured 
in the course of a few weeks, if the skin has not been broken, while 
the effects of the latter may, at best, remain for weeks or months, as 
weakness or stiffness of the joint. 

In the treatment of sprains, perfect rest of the injured part is es- 
sential. We do not mean to say that they are never cured without 
this, but never so speedily and completely ; and, without it, there is 
always great danger of bad consequences ; therefore, the patient, 
as soon as it has been ascertained that there is nothing more than 
a sprain, should take to his couch or sofa, and remain there, espe- 
cially if the injury is in the ankle or knee, or any part of the leg, 
in which case the limb should be kept in a horizontal position. 
Should the person, at the time the injury is received, know that it is 
only a sprain, he may prevent much of the evil consequence by the 
immediate application of cold, as by letting water run on the part 
from the faucet ; this will prevent the congestion and swelling in 
great degree. Later, warm moist flannels should be applied to the 
part by day, and a warm bread-and-water poultice at night ; should 



CLUB-FEET. 253 

this not reduce the swelling and subdue the pain in the course of 
twenty-four hours, leeches may be applied, and repeated two or three 
times if required. When the tenderness has in a measure subsided, 
a piece of lint dipped in vinegar, or diluted acetic acid, may be laid 
over the part ; this will, probably, bring out a pustular eruption of 
the skin, and divert the low inflammation from the ligaments, at a 
time when stimulating friction could not be borne. When the pain 
has entirely ceased, and the joint has resumed its usual appearance, 
great caution is necessary in using it, as irreparable mischief often 
results from too great activity at that time. If it continues swollen, 
it should be bound up with straps of soap-plaster, or a roller, and 
stimulated by frictions. 

CLUB-FEET. 

These are nearly always congenital, that is, dating from birth ; 
they are caused by the greater contraction of some muscles than 
others, by which the foot is drawn out of its natural position ; it 
may be inward or outward, although the former is most frequently 
the case ; or it may be an extreme elevation of the heel, so that the 
patient in walking rests altogether on the toes; this is the most 
simple form of distortion ; it is commonly called the horse-foot, and is 
not so frequently congenital as the other forms. It may arise from 
some disorder of" the system, and especially from nervous irritation ; 
it is frequently accompanied by weakness of the ligaments of the 
ankle-joint, and in this case, if not soon attended to, the foot is likely 
to become so distorted that the patient in walking rests merely upon 
the outer edge. There are many mechanical contrivances for the 
cure of these various deformities, which do not amount to malfor- 
mations, as in most cases the bones are merely drawn out of their 
natural position; but the best method is that of a subcutaneous 
division of the contracted tendons ; it is recommended as well for 
infants of the earliest age as for those grown up : first, from the 
facility with which it is accomplished ; secondly, because it incurs 
comparatively no risk, and scarcely any inconvenience ; and thirdly, 
because you at once overcome the principal resistance, and render 
the after-treatment painless to the patient, and comparatively easy 
to the attendant, independent of which the child is not subjected to 
such constant confinement of the limbs as is absolutely necessary 
when you do not have recourse to an operation. You can allow ex- 
ercise to be taken for a certain time , during the day, and that, even 
in infants, must have a most beneficial effect. Let every mother, 
then, who has a child with a deformed foot, at once consent to the 
performance of an operation, which is almost sure to be successful, 



254: DISEASES OF BONE AND TENDONS, AND DEFORMITIES. 

and which involves at the time but little pain, which leaves no ex- 
ternal wound, and causes no loss of blood. Splay or flat foot is 
the condition left when the arch of the foot is broken down by rup- 
ture of tendons. 

ANCHYLOSIS. 

A stiff joint, caused by the union of two separate bones by fresh 
osseous matter formed between them. This union is called either 
true or false : in the former case it is formed of lymph, thrown out 
by two ulcerating surfaces, blending together in one mass, and be- 
coming organized; in the latter, it is merely a jointure of the liga- 
ments, which, becoming stiff, results in immobility of the joint. If 
the stiffening of the joint is complete, there is no remedy for it, unless 
in a surgical operation ; if, as is sometimes the case, it is only par- 
tial, warm salt-water bathing, with daily attempts at movement, and 
friction, with cod-liver or other oil, may do much toward a restora- 
tion of the limb to its former state of usefulness. 



WHITE-SWELLING. 

This is a disease of a chronic character that occurs chiefly in the 
knee-joint, although it may occur in the elbow, hip, and even the 
ankle joints ; its occurrence elsewhere than in the knee is exceptional. 

The first symptom is often a deep-seated, dull, heavy pain in the 
joint, which is not constant nor severe, but is usually much in- 
creased in using the joint. It is generally seated in one particular 
part of the joint. In white-swelling of the knee-joint, the patient 
keeps the knee bent, and, from the pain occasioned by extension, 
gets into the habit of only touching the ground with his toes. At 
first there is no external swelling or inflammation, but in the prog- 
ress of the disease the knee swells, and gradually increases in size, 
but the skin is not at all altered in color, and the swelling is gener- 
ally so firm as to yield very little to pressure. In the slowness or 
rapidity of its progress, and in the severity of the pain, the disease 
differs much in different cases. Sometimes the pain is very acute, 
and the swelling gradually attains to a very large size. In the end, 
collections of matter often form about the joint, and at length burst, 
and discharge a thin curd-like matter. But it is not unusual for the 
disease to continue for several years, without the formation of any 
abscess, particularly if the patient has been under correct treatment. 
When the disease goes on to a fatal termination, hectic fever arises, 
and destroys the patient, unless the limb be removed. 

Tkeatment. — This disease is scrofulous in character, and the 



SPWA BIFIDA 255 

treatment must combine means which are capable of restoring firm- 
ness and health to the general system, with those which are more 
dirgctly calculated to arrest the progress of the local injury. Local 
measures are of the utmost consequence, but general means, of an 
invigorating nature, must be resorted to at the same time ; and it is 
from this union, and from this alone, in the majority of instances, 
that any one can reasonably hope to conduct the complaint to a 
favorable issue. 

One of the most satisfactory local applications is the sea-weed 
poultice made by bruising the common bladder sea- weed. If this 
is not accessible, an imitation of it may be made by wetting rags 
with salt and water, and the tincture of iodine, as the weed doubt- 
less owes its efficacy to the iodine and the salt (chloride of sodium) 
that are in it. Lisfranc, of Paris, found benefit in the internal use of 
medicines analogous to sea-salt, as the muriate of baryta (chloride 
of barium). 

The medicines to be used are iodine, iron, cod-liver oil, and qui- 
nine. An excellent way to combine the best of these is by putting 
two to four grains of the iodide of iron in every ounce of cod-liver 
oil. Another good form of iron is the tincture of the chloride. The 
chloride of barium may be added to this, or the latter medicine may 
be taken in solution alone, as sold by the apothecaries, five drops to 
a dose. It must be continued a long time, to have any effect. 

At the same time, the patient must have the advantage of a pure 
country air, and as much of it as can possibly be taken without 
exercising the affected limb ; and he must retire and rise early, and 
sleep on the mattress. 

A generous diet is proper, but care must be taken never to load 
the stomach, or to take any indigestible food, however small in 
quantity, since excess or imprudence in these respects will rarely 
fail materially and immediately to injure the joint. The joint must 
be kept perfectly quiet, and the straight position of the limb is in 
general the best. 

SPINA BIFIDA. 

There is a tumor somewhere along the course of the spine that 
can be felt to fluctuate. It is most tense when the child is upright. 
It is semi-transparent, the skin being drawn thin, and showing the 
tissue of vessels through it. This is due to deficiency of part of the 
bones of the spine, by which the membranes of the spine and the 
spinal fluid force through and form the tumor beneath the skin. 
The disease is not necessarily fatal, but yet leaves small hope for 
life, especially if the tumor is large. Domestic treatment is useless. 



256 DISEASES OF BONE AND TENDONS, AND DEFORMITIES. 



WRY NECK. 

By this distortion the head is either turned permanently .one 
way or the other, or is drawn down to one or the other shoulder. 

The cause may be unnatural contraction of the muscles of one 
side ; or it may be paralysis of the muscles of one side, in conse- 
quence of which the natural contraction of the other side produces 
the deformity. In cases in which it is caused by unnatural contrac- 
tion, division of the muscle by a surgeon is the best remedy, unless 
the contraction is dependent upon rheumatism, in which case the 
cure of the rheumatism will probably cure the deformity ; where the 
cause is paralysis, tonics, stimulant applications, frictions, and elec- 
tricity, should be tried. 



THE CHAPTER OP ACCIDENTS. 



WOUNDS. 

Ainr solution of continuity in a soft part of the body, occasioned 
suddenly by external causes, and generally attended with hemor- 
rhage at first, is a wound. It may be one or the other of six kinds. 
1. An incised wound, made by a sharp instrument, effecting a sim- 
ple division of the fibres. 2. A lacerated wound, one in which the 
fibres, instead of being cleanly divided by a sharp instrument, are 
torn asunder by violence ; the edges in this case are not straight, 
but jagged and uneven. 3. A contused wound, one made by a vio- 
lent blow from some blunt instrument, or unyielding surface ; this 
resembles the preceding. 4. A punctured wound, one made with 
a narrow, pointed instrument, as a sword or bayonet. 5. A poisoned 
wound, such as the bite of a viper, mad-dog, etc., or a slip of the 
knife in dissecting bodies in a state of decomposition. 6. Gunshot 
wound, which is at once contused, lacerated, and punctured. 

The treatment of wounds must, of course, depend very much 
upon their character ; if it be a clean cut or chop, we should first 
stanch the blood, by bathing it with cold water, cleaning away 
any extraneous matters with a soft sponge ; then bring the edges 
of the wound together so that they shall unite evenly, and fix them 
so, with straps of adhesive plaster; a space being left between each 
slip for the escape of any blood or matter which may form. Should 
the wound be of any great magnitude, so that the edges gape when 
unconfined, they should be drawn together by means of two or three 
stitches ; in making which, a threaded needle (a curved one) should 
first be passed through the flesh, inward, about one-quarter of an 
inch from the edge of the wound, then on the other side outward ; 
the ends of the thread are then to be brought together and tied 



258 THE CHAPTER OF ACCIDENTS. 

tightly ; the stitches should be an inch or more apart, they must not 
be drawn or dragged together with great force, or they may cut 
through the parts, nor must they remain in too long, or they may 
cause irritation : from two to four days will be sufficient for them to 
answer every useful purpose ; between them, strips of adhesive 
plaster should be placed, and, if a limb, a roller bandage should 
cover the whole. If the plaster is not readily procurable, a piece 
of linen may be bound round, and smeared with white of egg. 
Should the wound become painful and throb, and the patient feel 
chilly and uneasy, it is likely that there is matter forming which 
requires a way of escape ; in this case remove the plaster by wash- 
ing it with a sponge dipped in warm water ; then either put on a 
warm poultice, or lint, dipped or saturated with warm water, with a 
piece of oil-skin over it, to prevent rapid evaporation ; this mode of 
operation should be continued until pain and inflammation cease, 
and nothing but healthy pus is discharged. Simple strapping with 
adhesive plaster will then be the best treatment. 

This is the plan for clean incised wounds, and in other wounds 
the first attempt should be to give them the character of clean-cut 
wounds. If, for instance, there is a puncture, cut it down at both 
sides, to make it a wound of the first variety, because that is the 
wound that heals best. If it is a laceration, make the edges as 
clean as possible with the same view ; and, if contused, poultice, to 
hasten the sloughing, and bring it to the character of a simple 
wound as soon as may be. 

In a wound of the scalp, wash the part carefully with cold water, 
and remove all dirt or other matter which may have got under the 
skin ; then replace any flaps or strips which may have been torn up, 
if not quite detached, clipping the hair off as closely as possible all 
around the wound ; then cover the edges with strips of plaster so 
as to keep them together, and lay over that a piece of lint soaked in 
cold water, and, to keep the dressing in its place, apply a cross-band- 
age ; never cut away any pieces of skin. The patient should be kept 
perfectly quiet, and on low diet ; a little saline aperient will in 
most cases be necessary to cool the system, and subdue inflamma- 
tory symptoms. The dressing should be kept moistened with cold 
water for two or three days, applied so as not to disturb them. 
Sometimes in scalp-wounds there is much haemorrhage ; but this 
may generally be stopped after a little while by cold applications 
and pressure. If there is a single incision, and no great displace- 
ment of the skin, a stitch or two may be put through the edges, to 
draw them together. One of the greatest dangers to be appre- 
hended from a wound of the scalp is erysipelas, which spreads very 



BITES OR STINGS. 



259 



rapidly over the head, extends to the brain, and causes the death 
of the patient, unless its progress can be arrested. 

Lacerated or contused wounds bleed but little if any. In other 
wounds if the blood oozes slowly and is dark in color it is from veins, 
and may be stopped by the formation of a clot. Hasten this by 
washing the part with strong, cold alum-water. Bleeding is only 
dangerous when it is from cut arteries. This is known by the blood 
flowing by jerks, and by its bright-scarlet color. Pressure of the 
finger over the wound will, if the artery be small, stop the bleeding 
after a short time. If the bleeding recommences when the finger is 
removed, pressure may be made by twisting a handkerchief twice 
round the limb, over the wound; place a stick under the knot and 
give it several turns, so as to make firm pressure, thus : 

The pressure should only be suffi- 
cient to stop the bleeding ; beyond 
that it will bruise or injure the parts. 
Or, a piece of rag several times 
folded, and tied down with a broad 
piece of tape, or bandage, thus : 

If the bleeding proceed from a 
wound of an artery in a limb, and 
is not checked by either of the above 
methods, the current of the blood in 
the limb may be checked by pressure 
upon the main artery. Thus, if it be in the arm, firm pressure should 
be made downward in the neck, just above and behind the collar- 
bone. This pressure may conveniently be made by means of the 
handle of a door-key wrapped in a few folds of linen. 

If the blood flow from a wound in the hand, it may be considera- 
bly checked, or altogether arrested, by bending the elbow-joint, and 
firmly pressing the lower against the upper arm, so that the hand 
shall be able to touch the shoulder. Wherever the wound may be, 
the bleeding is to be controlled by pressure near it, or pressure in 
the wound, or by the use of cold applications or strong styptics, as 
the tincture of chloride of iron. 





BITES OR STINGS {Poisoned Wounds). 

1. Bites of Bisects. — These are simply poisoned wounds, and 
not what is generally understood by the word venomous or deadly. 

The symptoms produced will vary according to individual con- 
stitution, state of health, etc. Generally speaking, they are slight 
and confined to the part. The swelling may, however, extend over 



260 THE CHAPTER OF ACCIDENTS. 

a whole limb, or even over the whole body, and be attended with 
sickness, faintness, etc. 

Treatment. — If a sting be left in, it must be extracted with 
forceps or tweezers. The best local application is hartshorn or sal- 
volatile. If inflammation follow, it must be treated with cold lotions 
or poultices. 

If the effects produced be of the more serious character named, 
stimulants must be given freely — brandy in hot water ; ether ; sal- 
volatile. 

' 2. Bites of jSnakes, Dogs, etc. — In the case of a snake-bite of a 
venomous kind, the effects are so rapidly developed that only the use 
of instantaneous and energetic means offers any chance of saving 
life. The adder-bite is occasionally followed in a short time by 
serious consequences. 

These are only to be averted by the frequent administration of 
strong stimulants, such as teaspoonful-doses of sal- volatile in water 
every five or ten minutes, 'to an adult, and in reduced doses if a 
child. In some cases, life has been saved by the administration of a 
teaspoonful of eau de luce (a solution of ammonia with oil of amber) 
every five minutes, while the fearful state of depression continues. 

The explanation of this mode of treatment is simply that, the 
poison acting with lightning-like rapidity, there is not time to re- 
move it from the point at which it has been inserted, before it is 
traversing the whole course of the circulation. All that is left to us 
to do is to uphold the vital energies of the victim until it shall have 
lost its force, or been expelled from the system. How either may 
happen we know not. We may be thankful that life can sometimes 
be saved under such imminent danger. 

The local application of water of ammonia must always be freely 
made. Keep cloths wet with it constantly applied to the bite. The 
ammonia must not be strong enough to burn, as that will prevent its 
absorption. Rattlesnake bites have been treated successfully with 
ammonia alone. It must be applied to the wound, and also be 
given by the mouth. 

For dog-bites, apply a ligature tightly above the spot until 
strong caustic can be applied, or the part be removed by incision. 
If the bite be only superficial, the application of a stick of lunar 
caustic (nitrate of silver) will suffice. In deeper bites the stick of 
lunar caustic may be freely applied as soon as possible, if surgi- 
cal aid cannot be procured to remove the part. 

Hydrophobia seldom occurs. Compared to the number of dog- 
bites, its occurrence is as nothing. This fact, however, should not 
lead to neglect of the means above-mentioned, but should remove 



BR UISES.— CONCUSSION 261 

those alarming apprehensions which alone may disorder the nervous 
system and lay the foundation of serious symptoms. 

Never kill the dog where it is suspected that he is mad. He 
may not be mad, and this can only be shown by keeping him alive. 
If shown, it will have the best effect on the sufferer. 

BRUISES. 

Symptoms and Causes. — Swelling and discoloration of a part 
from violence applied ; the color undergoing changes from black to 
green and yellowish green, in proportion as the blood effused beneath 
the skin is absorbed. If a great quantity of blood be effused, inflam- 
mation and abscess may follow. 

Treatment. — Apply warmth and moisture by sponging, poul- 
tices, or lint or flannel wetted with tincture of arnica and water. 
Rest of the limb or part injured, and an elevated posture, to be 
maintained. As recovery takes place, the limb is to be very care- 
fully and gradually made use of, especially if a joint have been 
bruised, otherwise serious inflammation and permanent disease may 
be excited. 

Severer bruises may require the application of some leeches to 
the part, and attention to the general health. 

CONCUSSION OR COMPRESSION OF THE BRAIN. 

Injuries of the head from external violence are dangerous, as they 
involve the brain, which they do by compression or concussion. If 
the injury to the head be such that a portion of bone is driven 
inward, or blood is poured out on the surface of the brain, symptoms 
occur denoting compression ; they are insensibility and loss of vol- 
untary motion — laborious breathing, with a stertorous noise — slow, 
laboring pulse, but not generally intermitting — cold extremities — 
pupil of the eye much dilated, but no sickness, at least till the com- 
pression is removed by the use of the proper instrument, or other 
means. There is no return of feeling, so that the patient is insensi- 
ble to pinching, or other injuries inflicted, until the pressure is taken 
off from the brain. For compression of the brain the resources of 
domestic practice are vain. 

The symptoms of concussion are, total insensibility, the patient 
scarcely feeling any injury that may be inflicted upon him — loss of 
voluntary motion — difficult breathing, but in general without the 
stertorous noise — intermitting pulse — cold extremities — contracted 
pupil ; after a longer or shorter time, there is sickness — the pulse 
and breathing become better, and, though not regularly performed, 



262 THE CHAPTER OF ACCIDENTS. 

are sufficient to maintain life, and to diffuse a little warmth over the 
extreme parts of the body ; the feeling of the patient is now so far 
restored, that he is sensible if his sMn be pinched, but lies stupid 
and inattentive to slight external impressions. 

If it is simple concussion, a fatal termination is not likely ; but 
sometimes the shock causes rupture of the substance of the brain 
itself, or its enclosing membranes, or of one or more of its blood- 
vessels; in this case the patient may never rally from his state 
of stupor, or, if he does, it will be but for a short time ; there 
will probably be convulsions, paralysis, and apoplectic termination 
of his sufferings. All these are characteristic of inflammation 
(which see). In so acutely sensible an organ as the brain, it 
must be evident that an inflamed state of the tissue is by all pos- 
sible means to be avoided ; hence, when reaction sets in after the 
stunning and depressing effects of concussion have passed off, the 
most active measures should at once be taken. 

If the 'alarming symptoms increase in intensity, there may be 
sufficient warranty for an unprofessional person to bleed ; eight, ten, 
or twelve ounces of blood may be taken from the arm, or a dozen 
leeches may be applied about the head, or the patient may be cupped 
in the nape of the neck; the latter is perhaps the best mode of de- 
pletion, as it is effected quickly, and very near to the seat of dis- 
ease. The hair of the head should also be cut or shaved off, and 
rags wet with cold water applied; if iced, so much the better. 

It should be borne in mind that concussion of the brain is not 
always the result of a blow; it may be produced by a violent 
shock to the nervous system, such as that caused by coming down 
heavily on the feet from a leap. In cases of fracture of the skull 
(which see) the same symptoms as those described are likely to oc- 
cur, as in these there are generally both concussion and its common 
result, inflammation. 

The best treatment at the commencement of simple concussion 
is, to place the patient in a warm bed, to apply bladders of hot 
water over the region of the heart and stomach, and to employ 
gentle friction to the limbs. When he begins to recover, a little 
warm drink may be given, but no brandy, wine, or other stimulants, 
for all these cases are liable to be followed by inflammation, and 
we should have our eye to this probable consequence for many days 
after the receipt of such an injury. 

DROWNING. 

When any warm-blooded animal is immersed in fluid so that the 
lungs cannot obtain the supply of oxygen from the air which is ne- 



DROWNING. 2G3 

cessary to render the blood fit for the purposes of life, the result 
must be a cessation of the vital functions — a suspension, temporary 
or permanent, of all the operations of existence; this state is called 
asphyxia. The first effort of a drowning person is to breathe; 
a forcible expiration of air takes place, which contracts the lungs, 
and an attempt at respiration immediately follows, but this is ren- 
dered impossible by the interposing water ; again the effort is re- 
peated, and a few bubbles of the air thrown out rise to the sur- 
face, but none returns to supply its place ; the blood is passed back 
to the heart of a dark color, being loaded with carbon ; sensibility 
and the power of voluntary motion begin to diminish, and quite cease 
directly the arterial blood has lost its bright-red color and become 
wholly venous. It is calculated that about one minute and a half 
of total submersion is sufficient to effect this change, and to extin- 
guish animal life. But, by prompt and vigorous measures, it has 
been found possible to restore suspended animation, because the or- 
ganic functions go on for a considerable time after apparent death, 
which is not real until those functions have wholly ceased ; thus it 
is often with persons in a trance, or state of coma, exhibiting no 
signs of animation for a time, and yet eventually recovering the en- 
tire use of their limbs and faculties. The struggles of a drowning 
person, although undoubtedly violent, can be of but short duration ; 
if unable to swim, and the fall into the water is from any height, 
he goes at once to the bottom, unless it is in very deep water; but, 
going down with inflated lungs, and a considerable quantity of air 
in his clothes, he soon rises again, although he does not probably 
get his head far enough above water to inhale much air, in the hur- 
ried gulp which he is permitted to make before he sinks again ; he 
will probably come to the surface, or near it, a second, and a 
third time, but will, at last, sink to rise no more, until his body, by 
the gases generated in it by the process of decomposition, is ren- 
dered lighter than the surrounding fluid, and so rises and floats. In 
the violent efforts at inspiration which are made, some water must 
be swallowed, but not any thing like the quantity that is generally 
supposed ; little or none of it gets into the lungs or stomach. There 
is always some of it, mixed with frothy mucus, and sometimes with 
blood, in the trachea and bronchial passages, and this gives rise to 
the supposition that the body is full of water ; to get rid of which it 
was once the barbarous custom to suspend drowned persons by the 
heels, a sure method of preventing a restoration from a state of as- 
phyxia. The irritation of the glottis, excited by the unsuccessful 
efforts to breathe, and the rush of water directly the mouth is opened, 
especially if it be salt water, are so great as to cause a strong cough, 
18 



264 THE CHAPTER OF ACCIDENTS. 

which expels the fluid, and, when animation is altogether suspended, 
the passage is closed. There are indeed well- authenticated cases on 
record of recovery after five, six, ten, and even fourteen minutes' 
immersion ; but these are rare exceptions, and it may well be doubted 
whether, in these cases, the immersion was total and uninterrupted. 
Still it is but right to give the patient the benefit of this doubt, and 
make a prompt and persevering effort to restore him to life, al- 
though he may have been in the water much longer than even the 
longest of the above-named periods ; it is possible that he might 
have been able, by swimming, or taking hold of some floating sub- 
stance, to keep his head above water for a time, or to obtain a 
partial supply of air by lifting it occasionally. External warmth, 
artificial respiration, friction, and electricity, are the four great 
agents to be employed in the recovery of drowned persons: Let 
the body as soon as possible. — every thing depending on promp- 
titude and energy — be removed to some convenient place, the 
warmer the better, wrapped in blankets, and laid out on the floor, 
or a bedstead, which, being somewhat raised, will give greater 
facility for the necessary operations ; of course to strip off the wet 
clothes will have been the first of these; this should be done as 
soon as possible after the body is taken out of the water, and, if its 
removal to any distance is necessary, care should be taken to keep 
the head and shoulders well up, neither allowing the former to hang 
down backward, nor to fall forward on the chest. The patient then 
being placed on his back, with the forepart of the body raised by 
means of an inclined board, or pillows, the first care should be to 
free the mouth and nostrils of all obstructions ; next, to apply 
warmth to any available part of the body ; hot bran, salt, or sand, 
to the extremities ; hot flannel to the chest, abdomen, and sides, 
with stimulant liniments and plenty of friction ; camphorated oil, 
olive-oil with brandy or turpentine, or spirits of hartshorn, make the 
best liniments, and they should be rubbed on warm with flannel ; 
then, too, efforts should be made to bring the respiratory system 
into play ; not according to the old method, by thrusting bellows up 
the nostrils, or into the mouth, and so filling the stomach with wind, 
but by alternate pressure and relaxation of the ribs and parts adja- 
cent, so as to imitate the motion caused by breathing. 

For this purpose turn the body very gently on the side and a 
little beyond, and then briskly on the face, repeating these meas- 
ures cautiously, efficiently, and perseveringly, about fifteen times in 
the minute, or once every four or five seconds, occasionally varying 
the side. On each occasion that the body is placed on the face, 
make uniform but efficient pressure, with brisk movement on the 



DROWNING. 265 

back between and below the shoulder-blades or bones on each side, 
removing the pressure immediately before turning the body on the 
side. Or, with the patient on the back on a flat surface, inclined a 
little upward from the feet, draw forward the patient's tongue, and 
keep it projecting beyond the lips : an elastic band over the tongue 
and under the chin will answer this purpose, or a piece of string or 
tape may be tied round them, or, by raising the lower jaw, the teeth 
may be made to retain the tongue in that position. Remove all 
tight clothing from about the neck and chest, especially the braces. 
To imitate the movement of breathing — standing at the patient's 
head, grasp the arms just above the elbows, and draw the arms 
gently and steadily upward above the head, and keep them stretched 
upward for two seconds. (By this means air is drawn into the 
lungs.) Then turn down the patient's arms, and press them gently 
and firmly for two seconds against the sides of the chest. (By this 
means air is pressed out of the lungs.) Repeat the measures alter- 
nately, deliberately, and perseveringly, about fifteen times in a min- 
ute, until a spontaneous effort to respire is perceived, immediately 
upon which cease to imitate the movements of breathing, and pro- 
ceed to induce circulation and warmth. 

Electric shocks, slight at first, and gradually increasing in inten- 
sity, should also be passed through the upper portion of the spine 
and the chest, supposing the appliances are at hand for doing this ; 
these are, however, but subsidiary means — external warmth and 
friction are mainly to be relied on, and these should be persevered 
in for several hours if necessary ; strong smelling-salts, hartshorn or 
liquor of ammonia, may from time to time be applied to the nostrils, 
and a stimulant clyster be thrown up the anus, consisting of warm 
gruel with a tablespoonful of spirits of turpentine, or double the 
quantity of brandy. So long as unconsciousness continues, no 
efforts must be made to introduce any thing by the mouth ; but, as 
soon as there is a natural action of the lungs and heart, a percepti- 
ble pulse, and other symptoms of returning consciousness, a table- 
spoonful of brandy, with about the same quantity of hot water, 
should be given, and this dose repeated every half-hour or so, until 
the patient is sufficiently recovered ; he may then be placed in a 
warm bed, wrapped well in blankets, with hot applications to the 
feet if they still remain cold, and kept quiet for a time ; he will most 
likely sink into a slumber, more or less disturbed, according as his 
brain and nervous system are able to shake off the effect of the vio- 
lent shock which they have received. Heat, applied either by the 
warm-water or vapor bath, is an efficient auxiliary. As an incitement 
to long-continued exertion, we may mention that the recovery of a 



266 TEE CEAPTER OF ACCIDENTS. 

drowned person has been effected after a perseverance in the neces- 
sary means for four, six, and even eight hours. After recovery, it 
is likely there may be considerable congestion of blood about the 
brain ; therefore, if stimulants are considered necessary, they must be 
given with great caution, and there must be an avoidance of all undue 
excitement ; the diet should be nourishing but easily digestible : 
quiet is the great desideratum. 



HANGING. 

• 

Having cut down the body, immediately loosen the cord, or 
whatever it may be, about the neck ; then, as, unless the brain is 
relieved of the congestion of the blood caused by the pressure and 
consequent stoppage of the circulation, there will be no chance of a 
recovery, an effort should be made to open the temporal artery, 
which is most large and prominent on the side of the temple, 
nearly in a right line with the top of the ear; it may be done 
with a sharp penknife ; cold water should also be dashed in the 
face ; and, if blood flows freely, there is a chance that efforts to in- 
flate the lungs by the same means as those recommended under the 
head of drowning may be eventually successful. Persons will do 
well to make themselves acquainted with the exact situation of the 
main branches of the temporal artery, as there are several cases of 
emergency in which this knowledge is useful; it can be easily 
obtained by passing the hand over their own temples, and feeling 
where it beats. In suspended animation from drowning, hanging, 
or suffocation, the exact situation of the artery cannot be ascertained 
in this way, as of course there is no pulsation. 



LIGHTNING-STROKE. 

Death by means of this agent of Almighty power is not of un- 
frequent occurrence, and serious injury, short of death, sometimes 
results from it. The mischief in either case seems attributable to 
the shock received by the nervous system in the passage of the elec- 
trict fluid through some parts of the body ; sometimes, but not 
often, it is the result of a severe burning from the clothes being set 
on fire. 

When a person is " struck by lightning," he will be killed at 
once, in which case there will be unmistakable signs of death ; or 
only stunned, and then he will remain in a state of insensibility for a 
longer or shorter period, according to the shock which his system 
has received, or has strength to endure. There will be, probably, 



SUNSTROKE. 267 

slow and deep breathing, with a relaxed state of the muscular sys- 
tem, so that the limbs may be moved about anyhow, and will remain 
as they are placed. The state is, indeed, one of asphyxia, and should 
be treated like drowning. Artificial respiration should, if possible, 
be induced by the same means as those recommended under that 
head, and the animal warmth preserved by hot applications, friction, 
etc. ; mustard-plasters to the spine and pit of the stomach, and a 
warm clyster, containing half an ounce of turpentine, with, as soon 
as the patient can swallow, a little warm brandy-and- water or sal- 
volatile, in twenty-minim doses, every quarter of an hour or so. It 
is a popular notion that the bodies of persons killed by lightning do 
not become rigid, and that their blood remains in a fluid state ; this 
is quite contrary to fact. 

The proper course to be adopted, in the event of being overtaken 
by a thunder-storm, is to keep at some distance from trees, or tall 
buildings of any kind. Do not put up an umbrella, for the metal in 
it will attract the lightning, and a good soaking is a protection from 
the lightning ; for this reason, any thing metallic about the person 
should be got rid of or covered. If it be in a wide, open plain, 
where the body is the highest object, crouch as close to the ground 
as possible. In a room, do not stand between the fireplace and 
window or doors, for the course of the electric fluid appears to be 
much influenced by the current of air. 

SUNSTROKE. 

This is not identical with apoplexy, and the brain is perhaps 
principally affected in those only in whom it was not healthy before. 
The sufferer from coup de soleil is in a state of general exhaustion from 
exposure to great heat, and the lungs, heart, liver, skin, and kidneys, 
are as much deranged in their functions as the brain. Congestion 
of the lungs is found as often as congestion of the brain. 

Protect the person from the sun's rays, and rouse by application 
of cold water ; pour it on the head and on the throat and chest and 
stomach ; continue this at intervals till the person is able to swallow, 
and then give ammonia in brandy-and-water. 

SUFFOCATION AND SUSPENDED ANIMATION. 

This results from a stopping of respiration either by intercepting 
the passage of air to and from the lungs, or by inhaling smoke, 
dust, or air that is not respirable. Thus, death by hanging, drown- 
ing, stifling by carbonic-acid gas, or other mephitic vapors, are 
each and all suffocation ; although the term is usually considered to 



268 THE CHAPTER OF ACCIDENTS. 

signify only death by agents which do not compress the windpipe, 
but, by stopping the supply of oxygen to the lungs, render it unfit 
for circulation, and poisonous to the system. Suffocation often 
arises from very trivial causes ; too many clothes over the mouth 
of an infant will produce it ; swallowing a piece of food too large 
for the passage ; even a small piece of potato-skin over the opening 
of the larynx, so as to stop the passage of air, has done this ; so have 
a pin and a cherry-stone accidentally drawn into the air-passages, 
and husks of wheat drawn into the windpipe, as was the case with a 
young man whose head was thrust into a sack of bran. Infants 
have often been suffocated by being overlaid by heavy sleeping 
nurses or mothers, and they are always in danger of being so, when 
left with a bag of wash-leather, or piece of rag filled with sugar, or 
a raisin, to suck, and be kept quiet. People have lain down by 
lime-kilns and charcoal-fires, and met their death by asphyxia, 
which is but another name for suffocation. 

In every case of suspended animation the great object is to ex- 
cite respiration. For this, the fifth pair of nerves should be excited 
by forcibly dashing very small quantities of cold water on the face, 
or by stimulating the nostrils by ammonia, snuff, pepper, or the 
point of a needle. 

The spinal nerves should be excited by forcibly dashing cold 
water on the thorax and on the thighs, or by tickling, or stimulat- 
ing the sides, the buttocks, the arms, the soles of the feet, etc. 

If these attempts to excite respiration fail, inspiration is to be 
imitated by artificially distending the lungs. 

To effect this, the practitioner's lips are to be applied to those 
of the infant, or adult, closing the nostrils of the patient, and gently 
pressing the trachea upon the oesophagus. The chest is then to be 
pressed, to induce a full expiration, and allowed to expand, so as, if 
possible, to efiect a degree of inspiration. 

But it is important, in doing this, that the practitioner himself 
should previously make several deep and rapid inspirations, and 
finally a full inspiration. In this manner the air expelled from his 
lungs into those of the patient will contain more oxygen and less 
carbonic acid, and consequently be more capable of exciting the dy- 
ing embers of life. 

In the midst of these efforts it should, in the next place, be the 
office of two other individuals to maintain or restore the tempera- 
ture of the patient, by gently but constantly pressing and rubbing 
the limbs between their warm hands, passing them upward in the 
direction of the venous circulation. 

When respiration is established, the face must still be freely ex- 



INTOXICATION. 269 

posed to the air, while the temperature of the limbs and body is 
carefully sustained. 

As soon as possible, a little warm liquid, as barley-water, at 
blood-heat, should be given ; in the case of infants, by means of 
the proper bottle, furnished with leather or soft parchment. A tea- 
spoon must not be used, for fear of choking. If the infant draws 
the liquid through its own lips by its own efforts, there is no 
danger. 

Lastly, if all these remedies be tried in vain, galvanic or elec- 
tric shocks should be passed from the side of the neck to tlie pit of 
the stomach, or in the course of any of the respiratory nerves, and 
their appropriate muscles. No time should be lost in sending for a 
proper apparatus ; but, should the lapse of an hour, or even more, 
take place, before it can be obtained, still it should be sent for and 
tried. 

INTOXICATION. 

A drunken person is, to all intents and purposes, poisoned, and 
it is only a question of the quantity taken, or the power which the 
system possesses of resisting the influence of the deleterious matter 
forced into it, as to whether he shall die or recover. 

Some indication of the extent of danger to life, which exists in 
an intensely-intoxicated person, may be learned by the non-contracti- 
bility of the iris. If this shows no sensibility to light, or to any 
sudden motion made near it, there is little hope of recovery. The 
stomach-pump should be used to get rid of as much alcohol as pos- 
sible, and sickness excited by mustard, or any emetic, except anti- 
mony, which is too depressing; vinegar-and- water, hartshorn, or 
sal-volatile, may be freely given ; cold water poured on the head in 
a shower ; a turpentine injection thrown up, and mustard-plasters 
applied to the pit of the stomach and down the course of the spine. 
For ordinary drunkenness, pour cold water from a height on the 
back of the head. Use this remedy with caution, as it will be dan- 
gerous if the depression is great. (See Delirium Tremens.) 



BURNS AND SCALDS. 

Burns, the effects of heated solids, destroy more deeply than 
scalds, the effects of heated liquids ; the latter, however, are usually 
the more extensive. In scalding, blisters are usually formed. In 
burning there may be blisters, or the skin may be charred and its 
structure destroyed. The latter are, therefore, the more severe in- 



270 THE CHAPTER OF ACCIDENTS. 

juries. The danger is in proportion to the extent of the skin de- 
stroyed, and the nature of the part injured. 

Treatment. — In severe cases, if the burn have been occasioned 
by the clothing taking fire, the clothes are to be immediately re- 
moved, or cut off as quickly as possible, taking all possible care not 
to break any blisters. Those portions that stick should not be dis- 
turbed. The rest of the body should be kept warm. If there be 
shivering or faintness, warm wine-and-water should be given. 

In either severe or slight burns or scalds, the most correct prin- 
ciple to guide the selection of applications is to keep up the heat of 
the part at first, and bring it down gradually to the ordinary tem- 
perature. The first and most important object is to protect the 
surface from the action of the air. For this purpose, flour, cotton- 
wool, and wadding, are the readiest means. In slight cases these alone 
will be sufficient, and may be left on for several days. In severer 
and more extensive injuries the parts should be covered with strips 
of linen or lint spread over with ointment, consisting of equal parts 
of yellow basilicon and spirits of turpentine. 

The dressing should be changed once in twenty-four hours, or a 
liniment, as follows : 

Lime-water, 1 part. 

Linseed-oil, 2 parts. 

Well shaken together, and applied by lint or linen soaked in it. 

Cold applications are objectionable, as the relief they afford is 
but temporary, while the reaction which follows their use augments 
the pain and inflammation, and in extensive burns or scalds pro- 
duces a dangerous depression of the system. 

The water contained in the blisters is to be carefully retained, as 
it affords protection to the tender skin beneath. 

That which is most to be apprehended in severe burns is the 
great constitutional depression which often follows the excitement 
and severe pain ; especially is this the case with children, and when 
the seat of this injury is the chest or abdomen, or other vital part ; 
hence the effects should be closely watched, and stimulants adminis- 
tered, if there are such symptoms as shivering, pallor of counte- 
nance, sinking of the pulse, or coldness of the extremities. Am- 
monia, wine, or spirits, must then be given in doses sufficient to 
arouse the failing powers, without too much exciting the brain. If 
there is excessive pain, a slight opiate should be administered to 
allay the irritation of the nervous system, which, however, frequent- 
ly receives so severe a shock as to lose its sensibility for a time ; 
and when this is the case there is great reason to apprehend a fatal 



COLD. 271 

result. A "burn, if properly treated, and unless very severe, will gen- 
erally do well, and require little after-dressing ; but if the blisters 
are suffered to break, and the true skin beneath becomes inflamed 
by exposure, matter will be secreted, and troublesome ulcerations 
formed. Bread-and-water poulticing will be the best treatment in 
this case, with Goulard lotion, if there is much inflammation, or an 
ointment composed of extract of Goulard, one drachm, mixed with 
one ounce of fresh lard ; this should be applied spread on soft linen. 

When the burn is deep, after the flour has been on for some 
days, poultices as above should be applied until the coating of flour 
all comes away, and the wound looks clean and clear ; after which 
the simple water-dressing will be best, and when nearly healed the 
Goulard ointment as above. 

When parts immediately contiguous are involved in the burn, 
care must be taken to interpose dressings, or they may become per- 
manently united. 

After the more immediate constitutional effects of a severe burn 
have passed off, it will be necessary to be careful as to the patient's 
diet, which should be sufficiently nourishing and stimulative, es- 
pecially while there is any discharge ; taking care, however,, to re- 
duce it if febrile symptoms should set in. So constantly are these 
painful accidents occurring, and so frequently does it happen that 
the care of a medical man cannot be obtained for them, that it be- 
hooves all heads of families to make themselves acquainted with the 
best remedial measures. When they are very severe, every possi- 
ble effort should be made to obtain medical aid ; if they are but 
slight, this may well be done without. It should be borne in mind 
that the principal aims in the treatment of such cases are, first, the 
protection of the injured parts from atmospheric influence ; secondly, 
to keep down inflammatory action, both local and constitutional ; 
and thirdly, to soothe the nervous irritation which may arise, and to 
sustain the system should too great depression take place. 



COLD (Frost-bite, etc.). 

Intense cold produces drowsiness, paleness of surface, feebleness 
of pulse, and death. 

If a part of the body, as the nose, ears, toes, be exposed to se- 
vere cold, it is very prone to become frost-bitten; it turns of a 
dead- white color, then livid and shrunk. If not carefully treated, 
mortification will follow. 

Tbeatmext. — Rub the part with snow until reaction is estab- 
lished ; then with, cold water. The patient should very gradually 



272 THE CHAPTER OF ACCIDENTS, 

be exposed to warmth, lest the reaction should be too great. If a 
person who is insensible from exposure to cold is taken into a warm 
room at once, he will almost certainly die. Stimulants may be very 
gradually given as the patient is brought from one room to another 
till he reaches a proper temperature. 

CRAMP. 

An involuntary and- painful contraction of the muscles, often 
causing the most acute pain ; the legs and arms are the parts most 
likely to be affected by it, but especially the former ; sometimes it 
is general, as in cholera, affecting the whole muscular system, but 
most frequently local. Its principal exciting causes are pressure 
and irritation, arising from the presence of indigestible food in the 
stomach, or a superabundance of acid in the bowels; pregnant 
women are much subject to it, and those who have worms ; it often 
accompanies obstructed menstrual discharges, and impeded circula- 
tion ; when it affects the arms and fingers, there is reason to appre- 
hend disease of the heart, or of the large vessels of the chest, and 
medical advice should be at once sought. Sudden and prolonged 
cold will often produce general cramp, depriving the patient of all 
power of movement ; hence it is that bathers, who at one moment 
are floating buoyantly on the wave, full of life and activity, some- 
times sink the next. If the swimmer is seized by cramp when in 
deep water, and far away from help, there is no hope for him ; he 
goes down like a stone. 

The best immediate remedy for local cramp is friction ; let the 
leg, or other part affected, be well rubbed with soap or camphor 
liniment, mixed with an equal part of turpentine or spirits of harts- 
horn ; sometimes relief may be had by tying a band of some kind 
tightly round the affected limb between the seat of the pain and the 
body of the patient ; this is a perfectly safe process ; not so is the 
practice of standing upon a cold hearthstone, from which many find 
relief; this is likely to strike a chill through the whole system, and 
occasion permanent injury to the health. 

In all cases the bowels should be attended to, and freely evacu- 
ated by means of warm, stimulating aperients, such as the follow- 
ing: 

Powdered rhubarb and magnesia, of each ... 1 drachm. 
Spirits of sal-volatile and tincture of ginger, of each . . 2 drachms. 
Peppermint-water, 6 ounces. 

Mix, and take a tablespoonful every three hours until the effect is produced. 

If there is reason to suspect the presence of worms, take first 
two grains of calomel mixed with sugar, and put on the tongue ; 
three hours after, an active purgative. 



CHOKING.— PINS AND NEEDLES. 273 



CHOKING. 



When a piece of food too large for the passage sticks fast in the 
gullet, and cannot be removed, death from suffocation will be likely 
to ensue. Sometimes the obstruction can be pushed down into the 
wider part of the passage by means of a finger passed into the open- 
ing of the gullet ; or, if it cannot, this may be accomplished by 
means of what is called a probang, which is a smooth, round piece 
of whalebone, about two feet long, and as thick as a wheaten straw, 
to the smallest end of which a piece of sponge about the size and 
shape of a marble is firmly attached. Something like this may be 
extemporized out of the whalebone rib ,of an umbrella, or a very 
thin cane, having a knob of some soft yielding substance fastened to 
it. In using the instrument care must be taken to have the patient's 
head thrown well back, and to let the chief pressure be upon the 
back of the throat ; the instrument must be well oiled or greased in 
some way, and pushed steadily and quickly down until the obstruc- 
tion is felt to give way. If this should be a fish-bone or other 
jagged object, which is likely to penetrate the membrane, and get 
firmly fixed, the removal is not so easily effected. A little dexter- 
ous management of the fingers will often do this, as it is seldom far 
in the passage. If the obstruction remain long, and be of the nature 
last mentioned, it may cause inflammation and swelling of the part. 
If the obstruction be small, such as a single spine of fish-bone, some 
crumb of bread well masticated will probably carry it down. When 
it is removed there will commonly be a sensation as though the ob- 
stacle were still lodged in the throat, which keeps up the uneasiness 
in the patient's mind ; but, if still there, a distinct pricking may al- 
ways be felt when the throat is pressed. 

There is sometimes a spasmodic affection of the gullet which 
renders the act of swallowing difficult, and induces a belief that 
something is lodged there; this may be attributed to spasm or 
hysteria, if it is not caused by the effort to swallow too quickly. 

PINS AND NEEDLES. 

Pins and needles are sometimes swallowed, the careless and rep- 
rehensible practice of holding them in the mouth conducing to this 
result ; unless they occasion inconvenience by sticking in the throat, 
it is better to let them alone ; the latter will generally work their 
way out of the body, and the former, which, on account of their 
heads, cannot so well do this, will, in process of time be dissolved 
by the action of the acids of the stomach on the softer metal of 
which they are composed; a little vinegar taken now and then will 



274 THE CHAPTER OF ACCIDENTS. 

assist this process ; if they occasion much pain, and a pricking sen- 
sation in the bowels, demulcents and gentle aperients should be 
administered ; castor-oil is, perhaps, the best. When a needle, in 
making its way out of the body, approaches the surface, there will 
be a black dot or a line visible, with perhaps inflammatory symp- 
toms; it is best in this case to cut through the intervening skin 
with a lancet, and extract the intruder by means of small tweezers ; 
quite large needles have in this way been taken out of persons who 
were not at all aware how and when they got in. 

FAINTING {Swooning). 

Temporary depression of the animal and vital actions, with pale- 
ness, cold perspiration, pulse feeble or absent from the wrist, respi- 
ration and sensation suspended for a short time. 

This state results from strong impressions, moral or physical, 
made upon the nervous system ; exhaustion consequent upon over- 
exertion ; fasting ; debility ; loss of blood ; affections of the heart ; 
sudden change of posture in delicate states of health, or in disease, 
e. g., cholera, etc. Sudden loss of large quantities of fluid, etc., as in 
the operation of tapping, and after delivery in child-birth. 

Treatment. — Let the patient be laid on the back, with the head 
placed low ; plenty of fresh air ; sprinkle the face with cold water ; 
give stimulants, as brandy-and-water, or sal-volatile from one-half 
drachm to one drachm in water, carefully, as the patient may not be 
able to swallow freely. 

ULCERS. 

The healthy ulcer has a florid appearance; the little red 
eminences, called granulations, are small and pointed at the top ; 
the surface of the sore is even with the surrounding skin, or only a 
little above it ; it secretes a bland, whitish, opaque matter, and its 
edges are thin, and even with the surface. Here the healing process 
goes gradually on until a cure is effected ; and all that is necessary 
to be done, in the generality of cases, is, to avoid every source of 
irritation, and to apply the cold-water dressing. Dip some rag in 
cold water, wringing it gently, lay it over the ulcer and inflamed 
parts, and then cover the whole with a piece of oiled silk. Renew 
this water-dressing five or six times a day ; and wind over the whole 
a small linen bandage. 

The irritable ulcer is exquisitely tender and painful, although 
it maybe but slightly inflamed; its surface is unequal, being in 
some parts high, in others very low, and without the florid appear- 



GANGRENE. 275 

ance of a healthy ulcer ; and the discharge is either matter mixed 
with blood, or of a thin, irritating nature. Often the margin of the 
surrounding skin is jagged and sharp. ISTo dressing is in general 
half so efficacious in it as the cold-water dressing. 

The indolent or chronic ulcer is characterized by the glassy 
and semi-transparent appearance of the surface, in which there is 
little or no attempt toward healing, the sore remaining nearly in 
the same state for a considerable time. The languid, indolent ulcer 
requires stimulating applications locally, in conjunction with a 
nutritious diet and strengthening medicines. It may be dressed, once 
or twice a day, with ointment of nitric oxide of mercury, or with 
tar-ointment mixed with an equal quantity of sublimed sulphur. 
Sometimes a stimulating lotion will answer better, as the solution 
of lunar caustic, five grains to an ounce of water, or a solution made 
by mixing together eight grains of oxymuriate of quicksilver and six 
ounces of lime-water, either of which may be applied twice daily. 
The part must be constantly bandaged after being dressed, and 
the patient should take gentle exercise. 

It is absolutely necessary that, in every case of obstinate or 
severe ulceration, the patient should endeavor to amend the state 
of the general health, by means of a nutritious diet, recourse to 
pure air, and the use of alterative and strengthening medicines ; for, 
if an ulcer be not healthy, it will always be much assisted in healing 
by this attention, and, when unusually obstinate and painful, will be 
quite intractable without it. In addition, therefore, to any local 
application made use of, let the patient take the iodide of iron or 
iron and quinine, or powder of sarsaparilla, twice or thrice a day, 
the bowels being kept regular by the occasional use of an aperient. 
The diet must be such as will invigorate and rectify impaired vital 
power. Whenever severe pain attends, a pill composed of a quarter 
of a grain of acetate or muriate of morphia and a grain of calomel 
will afford the most effectual relief. 

As it is frequently impossible that strict rest and the required 
posture can be observed, if the ulcer be on the leg the circulation in 
the limb may be favored and supported by bandaging the leg care- 
fully with a calico bandage from the toes to the knee ; or by sur- 
rounding the limb to the same extent with strips of adhesive plaster, 
leaving the space of the ulcer uncovered, in order that ointments or 
other applications may be changed as often as needed. 

GANGKENE. 

Its causes are excessive inflammation, which occasions a destruc- 
tion of vital power in the part or parts which it attacks ; or it may 



276 THE CHAPTER OF ACCIDENTS. 

be a less degree of inflammation acting upon a part the vital powers 
of which are feeble ; locally so, or showing the general debility of a 
weakened constitution. In this case, gangrene sometimes super- 
venes without any great amount of previous inflammatory action. 
A broken, or otherwise wounded, or ulcerated limb is most commonly 
the seat of gangrene, or it may be the fingers or toes, after they 
have been frost-bitten or crushed, or in some way deprived of their 
nervous energy. 

Symptoms. — When the result of high and active inflammation, 
there is severe pain in the part attacked, and generally a consider- 
able degree of swelling ; a blush overspreads the part, which grad- 
ually deepens to a dull purple, or brownish red ; if there is a run- 
ning sore, the discharge from it will cease ; very soon the cuticle 
will be raised by a vesication, from which, on breaking, will issue a 
bloody serum, after which the skin assumes a decidedly gangrenous 
appearance, that is, it becomes of a dull, yellowish-green color, and 
is perfectly insensible. During the progress of these changes there 
is great constitutional derangement, marked by a high degree of 
irritative fever, with a small, weak, quick pulse, generally irregular, 
and sometimes intermittent ; often, too, there are vomiting, and 
delirium, and hiccough ; the latter is one of the most characteristic 
signs of the disease in its more advanced stage, especially when gan- 
grene arises from a diseased state of the constitution; then, the stom- 
ach is extremely deranged, and this derangement of the stomach is 
followed by a spasmodic contraction of the diaphragm, producing 
the cough. This symptom, therefore, does not arise from any alter 
ation in the diaphragm, but from its sympathy with the deranged 
state of the stomach. When gangrene is the result of a low degree 
of inflammation acting upon a weak system, there will probably be an 
absence of the febrile symptoms, or they will be but slight ; there 
will be the same discoloration of the skin, vesication, discharge of 
bloody serum, and morbid appearance ; this is also the case when 
the disease is produced by extreme cold. 

Teeatment. — In the active inflammatory stage, local depletion 
by means of leeches should be resorted to, and also bleeding from 
the arm if the state of the patient's system is such as to warrant 
this ; but not more than eight ounces of blood should be taken at 
one time, lest the vigor of the circulation be too much diminished, 
and, as a consequence, the nervous power of the constitution also. 
Soothing fomentations and warm poultices should be applied to the 
part ; calomel, or some other mercurial preparation, should be 
administered, to keep the secretions of the liver and intestinal canal 
in a proper state, and opiates to tranquillize the system. When 



FISH-HOOKS.— POISONS. 277 

gangrene is the result of cold, the treatment will be somewhat 
different. In this case the part affected becomes first white, and a 
restoration of the suspended circulation should be attempted by 
rubbing with snow, if it can be procured ; if not, with a coarse cloth 
or flesh-brush. ~No heat must be applied; even that of the bed- 
covering will sometimes set up inflammation. Camphorated spirit 
of wine is, perhaps, the best liniment that can be used. After the 
rubbing, if it appears to be at all effectual, apply cold poultices. 
If, in spite of these efforts, a discoloration of the skin shows that 
gangrene has really commenced, apply some gentle stimulus to the 
part, such as a poultice of linseed-meal mixed with beer-grounds, 
and also spirit lotions, to keep the disease from spreading. The 
constitution of the patient must be soothed and supported by some 
anodyne and stimulant ; Sir A. Cooper recommends from seven to 
ten grains of carbonate of ammonia, with twenty or thirty drops of 
tincture of opium, two or three times a day, or more frequently if 
required. In hospital practice a bolus composed of five grains of 
carbonate of ammonia, with ten grains of musk, is given every four 
hours in such cases, with excellent effect. Bark was formerly much 
used, but quinine has now taken its place. When the gangrene has 
proceeded to a sloughing sore, a port-wine poultice is a good appli- 
cation, as are spirits of turpentine, to stimulate the parts. 

FISH-HOOKS. 

If a fish-hook is caught in the flesh, depress the shank so as to 
find the exact whereabouts of the point, then with a sharp knife cut 
through all the flesh included in the hollow of the hook between 
shank and point. This will seem like making a large wound, but 
this wound will give eventually far less trouble, and will heal bet- 
ter, than would one left by the most skilful extraction of the hook 
without cutting. 

POISONS. 

The action of a poison may be both local and general, or re- 
mote ; the first, in chemically destroying the part with which it 
comes in contact, as the mineral acids and alkalies do by corrosion ; 
as cantharides and mustard, by irritating and inflaming ; or as mor- 
phine, aconite, prussic acid, etc., by paralyzing the sentient extremi- 
ties of the nerves. As instances of the remote action, we may men- 
tion that of cantharides on the urinary organs ; of mercury on the 
salivary glands ; of digitalis on the heart ; and of strychnine on the 
spinal marrow. Again, poisons generally, whether they corrode, ir- 
ritate, or produce no apparent alteration on the part to which they 



278 THE CHAPTER OF ACCIDENTS. 

are applied, destroy life by producing a fatal impression upon a 
remote vital organ. 

With a view to furnish a general theorem for the administration 
of antidotes, Dr. Paris drew up the following synoptical table of 
poisons : 

CLASS I. 

Poisons which act primarily through the medium of the nerves 
without being absorbed, or exciting local inflammation. 

Order 1. — By which the functions of the nervous system are 
suspended or destroyed. 

Death by Suffocation from Paralysis of the Respiratory Muscles. 
— These are alcohol, aconite, camphor, essential oil of almonds, salts 
of lead, croton tiglium, opium, oil of tobacco. The fourth and sev- 
enth of these may also act by being absorbed ; the third and fifth 
may have also a local action. 

Order 2. — By which the heart is rendered insensible to the 
stimulus of blood. 

Death by Syncope. — These are, infusion of tobacco, upas antiar, 
etc. 

CLASS II. 

Poisons which, by entering the constitution, act through that 
medium, with different degrees of energy, on the heart, brain, and 
alimentary canal. 

Death from many Causes.— These are, arsenic, camphor, coccu- 
lus indicus, hellebore, hemlock, henbane, lettuce, meadow-saffron, 
muriate of baryta, nightshade (deadly), opium, prussic acid, savin, 
squill, tartar-emetic. Of these, camphor, nightshade, and opium, 
have also a local action. 

CLASS III. 

Poisons which, through the medium of the constitution, expend 
their energies upon the spinal marrow, without directly involving 
the functions of the brain. 

Death by Tetanic Convulsions. — These are, nux vomica and the 
whole tribe of strichnos. 

CLASS IV. 

Poisons which produce a direct local action on the mucous 
membrane of the alimentary canal. 

Death by Gangrene. — These are, bryony, caustic alkalies, con- 
centrated acids, corrosive sublimate, cantharides, colocynth, elate- 
rium, euphorbium, hedge-hyssop, muriate and oxide of tin, nitrate of 
silver, nitre, ranunculi, zinc, verdigris. 

With those of the irritant class, we have generally violent vom- 



IRRITANTS. 279 

iting, purging, and intense pain in the abdomen, usually occurring 
within half an hour of the swallowing of the deleterious substance ; 
with those of a corrosive nature, the effect is immediate, an acrid, 
burning sensation in the throat attending the act of swallowing the 
poison. The narcotic class produce vertigo, paralysis, coma, and 
sometimes tetanus ; these have no acrid taste, and do not, like the 
first, inflame the viscera, nor cause purging and vomiting. Nar- 
cotic irritants have a compound action — that is, their symptoms 
include those produced by both the other classes. When any of 
these symptoms come on suddenly to one who, up to the time of the 
attack, has appeared in good health, and especially if it be soon 
after swallowing either solids or liquids, we may reasonably suspect 
that he is poisoned, and should at once endeavor to find out what 
he has taken likely to produce such results. We should, however, 
bear in mind that there are certain forms of disease which, as it 
were, simulate the symptoms of poisoning : such are cholera, ente- 
ritis, peritonitis, strangulated hernia, hgematemesis, etc. 

In apoplexy, epilepsy, some diseases of the heart and brain, and 
rupture or distention of the stomach, we have the same symptoms 
as those of narcotic poisoning. It behooves us, therefore, to make 
close inquiry into the cause of the dangerous symptoms, and not 
adopt remedial measures too hastily, although we know that promp- 
titude in adopting the right measures is of vital importance. Hence 
we see how desirable it is that one skilled in the diagnosis of disease 
should be at once summoned in a case of suspected poisoning ; if the 
aid of such cannot be procured at once, it is better to adopt such 
means as a limited knowledge will suggest than to let the patient 
perish for want of help. It*is popularly believed that there are cer- 
tain antidotes for particular poisons, but this is not the case ; there 
are, therefore, a few principles to be kept in view all through the 
course of treatment : first, to remove the poisonous matter from the 
stomach as soon as possible ; second, to protect the coats of the 
stomach against the action of the poison, by involving it in some 
viscid substance ; third, to act upon the substance chemically so as 
to effect a change in its nature — to render it inert or innoxious — 
this, as we have shown, can in some instances be done ; fourth, to 
combat the constitutional effects of a poison by such means as apply- 
ing stimulants and antagonists to narcotics and the like. 



IRRITANTS/ 

In the first class, we have the strong acids and alkalies, including 
sulphuric, nitric, muriatic, and oxalic acids, with the several forms 
19 



280 THE CHAPTER OF ACCIDENTS. 

of caustic potash and ammonia ; arsenic, corrosive sublimate, calo- 
mel, and other preparations of mercury ; the sugar, carbonate, oxide, 
and other preparations of lead; Brunswick and mineral green, 
Scheele's emerald, with blue vitriol, and other preparations of cop- 
per ; chloride of zinc, with the sulphate of the same metal, common- 
ly called white vitriol ; nitrate of silver, tartar-emetic, savin, spirits 
of turpentine, cantharides; sometimes fish, especially shell-fish; 
meat, either too fresh or too stale ; and game, eaten in the condition 
termed " high." 

All these, then, and a variety of others, which might be named, 
are irritant poisons, which, when swallowed, usually occasion vomit- 
ing very soon, with the common signs of inflammation of the bow- 
els ; some of them, which are corrosive, such as the mineral acids 
and alkalies, produce a burning sensation extending from the gullet 
to the stomach, directly they come in contact with the mucous mem- 
brane, of which they effect the destruction; corrosive sublimate 
does this particularly, and is also instantaneous in its effect ; the 
other substances above enumerated are not so rapid, although they 
are equally if not more dangerous. 

ANTIDOTE TO IRRITANT POISONS. 

For the mineral acids the readiest antidote is water, of which as 
much as possible should at once be drunk ; this will dilute them, and 
then neutralization may be effected by carbonate of soda or potash, 
magnesia, soap in solution, chalk, whiting ; or, if these are not to be 
had, old mortar or plaster scraped from the walls or ceiling of a 
room ; ice and iced water are also beneficial. Oxalic acid also re- 
quires the same kind of treatment ; and as much of this as possible 
should be removed by the stomach-pump or emetics. For the alka- 
lies, such as pearlash and ammonia, vinegar may be given, or any 
diluent acid, such as lemon-juice, or tartaric acid, mixed with muci- 
lage or starch. Arsenic should be removed from the stomach as 
quickly as possible, and the hydrated peroxide of iron given in free 
doses with plenty of water. 

Corrosive sublimate, although not less deadly in its effects, is 
more manageable by simple albumen; the patient should, there- 
fore, swallow white of egg in considerable quantity, and then take 
a dose or two of castor-oil, with twenty drops of laudanum in each, 
to soothe the irritation of the bowels and carry off the poison, which 
the oil also helps to decompose. 

For calomel, red or white precipitate, or vermilion, the same 
course as above recommended should be pursued. 



NARCOTICS. 281 

Red lead and the carbonate of that metal are both insoluble 
substances; the great object, therefore, must be to effect their re- 
moval by purging and vomiting ; the bowels may be in some meas- 
ure protected from their action by mucilaginous drinks. Here, again, 
castor-oil is the best purgative. The same remedies should be used 
for sugar of lead, which is a soluble salt. 

For nitrate of silver, give a tablespoonful of common salt, with 
plenty of warm water. This decomposes the poison, and acts as an 
emetic also. 

For blue vitriol, verdigris, and the other preparations of copper, 
give white of egg and castor-oil. Several of these are themselves 
emetic, and will work their own expulsion with a little assistance, 
as will tartarized antimony, generally called tartar-emetic ; but, to 
prevent bad after-symptoms, it is best to neutralize the antimony 
with some bark, or galls, given in the form of powder or decoction ; 
to relieve the sickness, give opium, in grain-doses, every six hours. 

Chloride of zinc has a very rapid corrosive action ; it readily 
dissolves ; if speedily diluted with warm water, will itself act as an 
emetic. Encourage the vomiting, and after it give castor-oil. 

Spirits of turpentine, nitre, savin, and cantharides, besides their 
irritant action on the bowels, act specifically on the kidneys ; for 
these give emetics and castor-oil, with plenty of barley-water, or 
other demulcent drinks, with opiates. 

Fish, meat, and game, are generally beyond the reach of emetics 
before they produce their peculiar symptoms of poisoning ; give, 
therefore, a full dose of castor-oil, with laudanum, and if, as is often 
the case, there are colicky pains, give calomel and opium, of each a 
grain, every four hours, to the extent of six doses if required. 

NARCOTICS. 

Under the head of Narcotic Poisons we must place prussic acid, 
essential oil of bitter almondsj opium and its preparations, woody 
nightshade, alcohol, ether, chloroform, etc. 

ANTIDOTES TO NARCOTICS. 

The decomposition of the first two of these may be effected by 
means of ammonia ; therefore give a teaspoonful of sal- volatile or 
hartshorn in water ; apply strong liquor of ammonia, or smelling- 
salts, to the nostrils ; and, to stimulate the nervous system, pour on 
the back of the head and down the spine a stream of cold water 
from a jug held at a considerable height. Opium should be removed 
from the stomach by means of the pump, or strong emetics ; sul- 



282 THE CHAPTER OF ACCIDENTS. 

phate of zinc in thirty-grain doses every quarter of an hour, with 
plenty of • warm water, is the most effectual. Great drowsiness and 
stupor are produced by this poison, which must be combated by all 
possible means : a teaspoonful of sal- volatile in strong coffee is the 
best stimulant ; it should be repeated about every half-hour For 
at least twelve hours after swallowing the poison the patient must 
not be suffered to give way to the drowsy inclination, for if he sleeps 
he will probably wake no more; he must be kept constantly in 
motion, and be stimulated by pinching, pricking, flagellation with 
switches, or any means that may suggest themselves ; when it is 
found that the patient can keep awake for an hour by the simple 
exercise of his will, he may be suffered to sleep, but not before. 

Woody nightshade and hellebore must be removed from the 
stomach by the means above directed ; the soporific effects are not 
so strong as those of opium, and may be overcome by gentler means. 
Alcohol, ether, and chloroform, should be removed by the stomach- 
pump or emetics. Many deaths have occurred from inhalation of 
the latter, and in very few cases has it been found possible to restore 
animation when the state of syncope has supervened ; efforts should, 
however, be made to introduce air into the lungs, and to stimulate 
the muscles of respiration to action by passing the finger down the 
throat and tickling the entrance of the wind-pipe, etc., the same 
attempts to inflate the lungs as those directed under the head 
Drowning should be persevered in for a long time. Water should 
be gently sprinkled, but not dashed, in the face. 



NARCOTIC IRRITANTS, AND THE TREATMENT. 

The narcotic-irritant poisons are, nux vomica or strychnia, col- 
chicum, white hellebore, digitalis, belladonna, conium, monkshood, 
laburnum-seeds, yew-berries, poisonous mushrooms, etc. 

The first of these is one of the most deadly of vegetable poisons ; 
but, if free vomiting can be produced directly after it has been taken, 
there is a chance for the life of the patient, to whom, after the vomit- 
ing has ceased, should be given a teaspoonful of sal-volatile in water 
every two or three hours until he is sufficiently recovered. 

For all the rest of this class of poisons the same kind of treat- 
ment is necessary; colchicum and hellebore exhaust by purging, 
and by depressing the action of the heart, and this latter effect is 
ascribable to all. The stomach-pump or emetics, castor-oil and 
laudanum, followed by brandy and sal-volatile, are the remedies to 
be used. Poisonous mushrooms have been known to remain in the 



FRACTURES. 283 

stomach undigested ; therefore vomiting should be produced in this 
case, although the poison may have been long swallowed. 

There are many other vegetable poisons of the narcotic-irritant 
class, as well as of the other kinds here specified, which might have 
been included in the above list ; but, as allusion to all of them is 
made under their several heads, it was scarcely necessary to give 
them here. We have mentioned the principal poisons, and indicated, 
we trust with sufficient clearness, the general plan of treatment to 
be pursued. 

FRACTURES. 

In all fractures, the treatment has the same purpose in view : put 
the broken parts of the bone together as nearly in their natural rela- 
tion as possible, and use your ingenuity, by contrivances of splints and 
bandages, to keep the parts in position. Nature will do the rest, soon- 
er or later, as the health of the general system is better or worse. 
Keeping the general system in good condition contributes greatly 
to the cure. Union, but an insufficient one, takes place in a few 
weeks ; but two months is the earliest period at which a bone can 
be expected to be as firm at the broken place as at any other ; and 
in many cases this union comes much later. 

Fracture of the Finger. — After bringing the ends of the bone 
together by extension, place a small smooth piece of deal, or of 
gutta-percha, on the under, and another on the upper side, and pro- 
ceed to bandage somewhat tightly, so as to keep the finger extend- 
ed ; put the arm in a sling, and keep it so for about a month ; if 
the injured part swells and becomes painful, the bandage must be 
loosened, and a cold lotion applied ; this is generally by no means a 
difficult case to treat. 

Fracture of the Metacarpal Bones. — These bones, which inter- 
vene between the wrist and the fingers, should be treated in this 
manner. Place in the palm of the hand a soft but firm spherical 
body, and, closing the fingers and thumb over it, in a grasping 
position, keep them so with a bandage ; by this means the natural 
arch is preserved, which it will not be if flat splints, are applied ; in 
this case, too, the arm had better be slung, and from a month to 
five weeks will be the time required to effect a union. 

Fracture of the forearm may be either of the ulna or of the 
radius, or of both ; the former is the inner bone, and the thicker of the 
two. It may be broken at any part of its length, or at the elbow 
process, called olecranon. In the first case the plan will be to bend 
the elbow, and bring the hand into such a position that the thumb 
points upward ; use extension until no unevenness can be discovered 



284 THE CHAPTER OF ACCIDENTS. 

in the course of the bone, and then apply two splints, the inner one 
reaching from the bend of the elbow to the tips of the fingers, and 
the outer from a little beyond the elbow to the middle of the back 
of the hand, which should be raised well toward the chest, so as to 
make a sharp angle, and draw the ulna from the radius. When the 
fracture is in this latter bone, the same method must be adopted, 
only that the hand must be depressed instead of raised, in order to 
keep the two bones apart. When these are both fractured, the set- 
ting is, of course, more difficult, and much time has often to be 
spent in extension and manipulation, before the four broken ends 
can be brought properly together ; the splints should be put on as 
above directed, bandaging the hand firmly to the longer one, and 
placing it so that it is neither raised nor depressed, but in a right 
line with the axis of the arm. When there is fracture of the ole- 
cranon there is little or no power of extension in the elbow, behind 
which a bony lump may be felt ; a true osseous union in this case is 
scarcely to be looked for; but the injury will probably be repaired 
by a band of ligament. There are commonly inflammation and swell- 
ing, which must be reduced before pressure can be applied ; the 
arm should be kept straight, and wet with cold lotion ; and a splint 
applied as soon as it can be borne ; let it be a long one, reaching on 
the inside from the shoulder to the hand ; bandage the arm in a 
straight position, beginning from the top, and making, as you go, 
extension downward, so as to get the broken bone into its place ; 
it is long ere the limb is in a serviceable condition after a fracture 
like this. When the coronoid process is broken, the matter is more 
easily managed ; the forearm must be bandaged in a bent position, 
and kept so. In about a month slight exertion of the limb may be 
allowed, but there must be great care taken that it is not too vio- 
lent. 

Fracture of the humerus^ or upper-arm bone, very commonly 
takes place in the shaft, on any part of which, within an inch and a 
half of either extremity, it is easily detected by the mobility of 
the limb at the seat of the injury, and the patient's incapability of 
raising the elbow ; the broken ends of the bone, too, may readily 
be felt, and crepitation heard, when they are rubbed together. 
In this case, two wooden splints will be required, one to go before, 
and the other behind ; or, if the arm is very muscular, four may be 
necessary to embrace it properly ; they should be padded with tow, 
wadding, or lint, and furnished with tapes, to buckle, or tie, as may 
be most convenient ; the padding should be placed upon a soft piece 
of calico or linen, a little longer than the splint at each end, and 
three times as broad ; turn in the ends and sides, so that the pad is 



FRACTURES. 285 

a little larger than the splint every way, and about half an inch 
thick, and make all fast by tacking ; place the turned-in ends of 
the calico next the wood, so that there is a smooth surface presented 
to the skin. The splints may be placed, and made firm by means 
of tapes ; these should not, at first, be drawn tighter than is required 
to keep the splints right, and prevent movement of the arm. After 
the first few days, when the swelling has subsided, a more permanent 
investment of the limb may be made. First give it a pretty firm 
roll of bandage, then place two splints, one on each side, of stout 
pasteboard, gutta-percha, or leather, cut so that they will come down 
and cover part of the forearm. These splints should have been pre- 
viously shaped, or moulded, to the sound arm, and should be well 
fixed by more bandage, which, as it is rolled, should be brushed 
over with starch to prevent its slipping. Sometimes, where there is 
not much muscle, the starch-bandage is alone used ; but, in this 
case, the whole of it must be well saturated with strong starch, 
paste, gum, or white of egg, with strips of brown paper stuck down 
across the folds here and there. Care must be taken not to move 
the arm until all this is dry and firmly set. The hand and wrist must 
be supported with a sling, but the elbow had better hang free, as 
its weight will tend to keep the bone straight and the muscles ex- 
tended. 

Fracture of the neck of the humerus is that which takes place 
when the upper extremity, or head, is broken off. The symptoms 
here are very much like those which attend dislocation of the shoul- 
der, and the treatment must be much the same. Draw down the 
shaft of the bone, and push up the head by means of a pad in 
the armpit; then bringing the arm close to the body, with the 
lower part at right angles with the upper, fix it to the chest by a 
splint on its outside, and a long bandage encircling it and the whole 
body. 

Fracture of the collar-bone is, perhaps, one of the commonest 
accidents of the kind that can happen, and one of the most easily 
detected; it is generally occasioned by a blow on the shoulder, 
which falls forward, pushing the ends of the broken bone one over 
the other. The main object in the treatment must therefore be, to 
keep the shoulder back until the bone has united, and become suf- 
ficiently firm to do this without artificial aid. 

Make a pad of any soft material — a pair of old stockings, for in- 
stance — and put it in the middle of a large handkerchief; then 
place it well under the arm, on the injured side; the ends of 
the envelope are brought, back and front, over the opposite shoul- 
der, then crossed, and tied beneath the sound arm ; another broad 



286 1HE CHAPTER OF ACCIDENTS. 

bandage of some kind is then passed several times round the body 
and injured arm, so as to bind the latter closely to the former. 

Fractures of the Ribs. — These are of not unfrequent occurrence ; 
they commonly result from a fall or a blow, and may be complete 
or only partial, involving one or more of the bones. The symptoms 
are, a sharp pain felt at the injured spot, especially in breathing and 
coughing ; irregularity to the touch, and distant crepitation. The 
chief risk involved is injury to the lungs, from the sharp ends of the 
bone, and consequent inflammation ; hence it is usual to bleed pa- 
tients after this accident if the system will bear depletion ; leeches 
are sometimes applied to the seat of the pain, and hot bran-bags. 
A band of stout calico or flannel, from eight to ten inches wide, 
should be passed round the chest several times, beginning close 
under the armpits and going down to the end of the ribs ; it should 
be drawn so tightly as to keep the ribs from rising and falling in 
the act of respiration. The patient should be kept perfectly quiet, 
and on low diet, for a fortnight at least, assuming the position 
which is found most easy, which will probably be a half-sitting one, 
supported by pillows. 

Fractures of the Skull. — These are generally attended with in- 
jury to the brain, and are always very serious affairs, on account of 
the concussion which takes place, and the amount of cerebral mis- 
chief arising out of this. Domestic treatment can do little here ; pend- 
ing the arrival of the surgeon, the hair should be cut closely off 
about the seat of the injury, and cold lotions applied. It is not al- 
ways easy to ascertain whether the skull is really fractured, as a 
simple crack will be likely to escape notice ; but very commonly 
there is a depression ; and sometimes a portion of the bone is driven 
out of its place, exposing the brain and skull. 

Fracture of the nose often takes place, on account of the promi- 
nence of the feature, and the thinness of the bones. When any'of 
these are broken, there is nothing to be done, save to elevate them 
from the inside, by introducing some smooth instrument, such as a 
probe, or netting-pin. If the broken pieces of bone are kept in their 
places by means of sticking-plaster, they will quickly unite, and lit- 
tle or no disfigurement may result ; the necessary replacement 
should be effected before inflammation sets in, and cold lotions ap- 
plied to the part while there is any redness or swelling. 

Fractures of the Leg. — In this limb, as well as in the forearm, we 
have two bones, either or both of which may be broken : the main 
bone is called the tibia, and the smaller the fibula ; the knee-joint 
is formed by the first alone, but the second takes part in the for- 
mation of the ankle-joint. When the fibula alone is broken, the 



FRACTURES. 287 

setting is not a difficult matter, for the tibia acts as a splint to keep 
it in its place ; but it is so well protected by muscles and its posi- 
tion, that this seldom occurs. Should the tibia be fractured, the 
fibula supports the limb, and prevents any muscular contraction or 
displacement. The fracture in this case can easily be discovered ; 
there is distinct crepitus, and an unnatural prominence, or depres- 
sion felt, in passing the hand carefully along the shin. The fracture 
of the fibula is more difficult of detection, especially if it be in the 
upper part ; but this is very rare. When it does occur, it is gener- 
ally near the lower end, where it may readily be felt, even through 
the swelling. 

The leg must be placed in a box open at the top, the sides of 
which are properly padded to keep the limb in place, the limb being 
further supported by a bandage that, beginning at the foot, is put on 
evenly, fold over fold, up to the knee. With the ends of the bones 
put in position, this apparatus will be sufficient till union takes 
place. 

Fracture of the Thigh. — This is a very serious accident ; the 
bone may be broken just above the knee, in the shaft, or near the 
neck. In the first of these cases the nature of the injury is suffi- 
ciently obvious, as the broken bone can be felt beneath the skin ; this 
also is the case with the second, in which, as in the third, there is 
shortening of the limb, and generally turning out of the foot. 
This accident may be readily distinguished from dislocation of the 
hip, by the mobility of the hip-joint. There is always much difficul- . 
ty in keeping the ends of the bone in apposition here, in conse- 
quence of the power exerted by the muscles of the thigh, which are 
constantly pulling lengthways, and causing the ends to overlap, or 
" ride " upon each other ; this is especially the case if the frac- 
ture is oblique. It is best to use the long, straight splint first, 
in either of these cases, and to put it on with a light bandage, 
gradually tightening it, to accustom the limb to the pressure ; the 
splint must be made reaching from the hip to beyond the toes. 
When inflammation has subsided, and the pressure can be borne, 
the case had better be treated in this way : Let the patient lie on 
a hard mattress, with the leg extended and uncovered ; then com- 
mence operations by bandaging the leg evenly from the toes to the 
knee ; then place the splint, previously well padded, in its place, 
and make it fast with rollers to the foot, ankle, and leg, taking care 
that the former is in the position which it is to occupy — that is, 
pointing straight upward; next take a silk handkerchief, in the 
middle of which some wool has been rolled up, to make it of consid- 
erable thickness, and pass it between the legs, bringing one end up 



288 THE CHAPTER OF ACCIDENTS. 

behind, and one before ; these ends pass through the holes at the 
top of the long splint, and are tied as tightly as possible, without 
displacing the fracture. Then, after confining the splint to the waist, 
with a bandage, insert a short stick between the loop of the hand- 
kerchief, and give two or three turns ; this will have the effect of 
shortening the handkerchief, and pulling down the splint, which 
will carry with it the part of the limb attached to it below, produ- 
cing the necessary extension ; keep on at this, until you find that the 
injured leg is as long as the sound one ; and, when this is the case, 
lay a short splint along the inside of the thigh, and bandage tightly 
and smoothly, from the knee up to the hip. The extension must be 
kept up for about six weeks, at the end of which time the fracture 
may be sufficiently united to bear the strain of the muscles upon it. 



DISLOCATIONS. 

Dislocation is the " removal of the articulating portion of a bone 
from that surface to which it is naturally connected." This removal 
is generally effected by violence, and the primary object of remedial 
measures is to bring the point of articulation back to its natural 
position. When the muscles are only extended, and there is no 
laceration, or severance of a ligament, and no fracture of either 
of the bones, there is little difficulty in reducing common dislo- 
cations, if taken in hand shortly after their occurrence; but, if the 
•bones are suffered to remain long displaced, so that the muscles 
become accustomed, as' it were, to their new position, there is sure 
to be permanent distortion, and most likely lameness of some kind. 
The displaced bone, at its new point of contact with other bones, 
forms a connection therewith, and finds there a basis for its future 
movements and operations, it requiring as much force to remove it 
from thence as it did from its natural position. 

The joints most liable to dislocation are the hip, the ankle, the 
shoulder, the elbow, the lower jaw, the fingers and toes, and in these 
joints the detection of the dislocation is tolerably easy, even to the 
unprofessional person. 

The symptom of a dislocation having taken place is loss of 
power in the limb or member, which becomes fixed in one position, 
any attempt to move it causing extreme agony ; there is also a sen- 
sation of numbness in the part, and the patient feels sick and faint, 
probably on account of the severe pain; an examination of the 
joint also will show a deformity. 

Whenever there is a doubt as to the nature of the injury which 
has happened, it is always best to wait the arrival of a surgeon be« 



D1SL CA TIONS. 289 

fore making any violent efforts to reduce what is supposed to be 
merely a dislocation, but may in reality be that in combination 
with a fracture, or an injury of quite another kind ; but, when the 
case is tolerably clear, no time should be lost in effecting the reduc- 
tion ; this may be done by drawing down the limb or members un- 
til the ends of the dislocated joints are brought as nearly together 
as possible, then, if the pressure is relaxed, the muscles will general- 
ly draw them into their proper position, and hold them there ; care 
should be taken to keep the upper bone of the two which it is de- 
sired to connect firmly fixed, so that, in pulling the lower, the down- 
ward or outward, as the case may be, does not follow it, and so pre- 
vent the necessary extension of the muscles. 

Dislocation of the Shoulder. — If the dislocation is in the humerus, 
or shoulder, a very common part, pass a sheet or strong towel round 
the body of the patient, and fasten the ends to a staple in the wall, 
or some other fixed support ; then take another towel, and, making 
what is called a " clove-hitch," slip it over the elbow, draw it tight, 
and give the ends to two or three strong assistants, who must pull 
gently, yet firmly and steadily, for some minutes, while the operator, 
with his knee beneath the armpit, endeavors, by raising and depress- 
ing the bone as it is drawn out, to direct it so that, when it has at- 
tained a point of extension beyond the edge of the socket from which 
it has been displaced, it will slip back into it. A dislocation of the 
shoulder may be either forward or backward : although the latter is 
a rare case, it may be known by the swelling at the shoulder-blade, 
the flatness of the outside, and incapacity of movement ; the reduc- 
tion may be effected in the same way as above described. After it 
is accomplished, it is most prudent, in either case, to keep the arm 
confined to the side for some days by means of a bandage, as it may 
be thrown out again by the slightest attempt to use the limb. 

Dislocation of the Collar-Done. — This may occur at either end, 
but it is difficult for a non-professional man to detect this, and, if 
such an injury is suspected, it is best to summon surgical aid, com- 
pressing the parts, until it arrives, with a cross bandage. This acci- 
dent, however skilfully treated, usually results in some permanent 
deformity. 

Dislocations of the Elbow. — These are the most difficult to under- 
stand and to reduce of any, on account of the complication of joints 
at that part, where, it must be remembered, three bones meet, viz., 
the arm-bone (humerus), and the two bones of the forearm (radius 
and ulna), the second of which may be dislocated by itself, back- 
ward or forward, and the last only backward, carrying the radius 
with it ; two lateral displacements of the bones of the forearm also 



290 THE CHAPTER OF ACCIDENTS. 

sometimes occur ; and lastly, and rarely, a displacement in which the 
cartilaginous surface of the humerus rests between the radius and 
ulna : it must be evident that a thorough knowledge of the anatomy 
of the parts is required for the reduction of either of these ; therefore 
we need not enter into a description of the means to be used. 

Dislocations of the Wrist- Joint. — These are generally caused by 
the hand receiving the weight of a heavy fall ; it may be of three 
kinds, all of which may be distinguished from a sprain by the un- 
natural bony projections, either in the front or back, as the case 
may be, in contradistinction to the soft swelling only which is set 
up by the latter. The mode of reduction is this : let the patient's 
arm be grasped firmly, just above the elbow, by an assistant, while 
the operator, supporting the forearm with his left hand, takes hold 
of the patient's hand with his right, and the two, exerting their force 
in opposite directions, produce the extension necessary to replace 
the joints in their natural position. After the reduction a roller- 
bandage should be applied round the wrist, and a spHnt bound be- 
fore and behind the forearm, passing on either side down as far as 
the metacarpal bones. 

Dislocations of the Fingers and Toes. — These are of rare occur- 
rence, and, when they do happen, it is generally between the first 
and second joints; they may be easily known by the projection of 
the dislocated bones, and reduced without much difficulty, if done 
soon after the accident. They must be reduced by extension ; 
the clove-hitch, made with a piece of stout tape, may be used if 
there is much difficulty; the wrist during the operation should 
have a slight forward inclination given to it ; this will relax the 
flexor muscles. 

Dislocation of the Jaw. — A blow upon the chin, when the mouth 
is opened widely, will sometimes cause this, as will yawning or gap- 
ing very deeply ; by it the patient is placed in a very awkward posi- 
tion, with his mouth set wide open, and with no power to close 
it or to articulate words. This kind of dislocation may be either 
complete or partial; in the latter case the mouth is not opened 
so widely as in the former, and it may be known by the chin 
being thrown on one side, opposite to that of the displacement. 
There is not usually much difficulty in reducing a dislocation 
of the lower jaw; the upper cannot be dislocated. The plan is 
to wrap a handkerchief round each thumb, and, placing them in 
the inner angles of the jaw, the coronoid processes, as they are 
termed, endeavor, by forcing it backward and downward, to restore 
it to its proper position. Success will generally attend the effort, 
if only a moderate degree of force be used, especially if it be by a 



DISLOCATIONS. 291 

skilful hand. Some put a transverse piece of wood into the patient's 
mouth to serve the purpose of a lever, hut this is a rough method of 
operating, and no person skilful in manipulation need resort to it. 

Dislocation of the Sip- Joint. — This is one of the most frequent 
causes of lameness ; it may be caused by a fall, or coming down 
heavily on the feet from a leap, and frequently occurs to children 
through the negligence of servants. A careful mother will take 
note of the slightest alteration of the gait of her child, and institute 
an examination at once, for sometimes the displacement of the hip- 
joint in the young is attended with little or no pain, and the limp- 
ing gait is its only obvious indication, unless it be a manifest disin- 
clination to walk at all ; if it be a child in arms to whom the acci- 
dent has occurred through the carelessness of its nurse, the injury 
may remain undiscovered until the displaced joint has become too 
firmly fixed in its unnatural position ever to be restored to its nat- 
ural one, and a shortened limb, producing lameness for life, is the 
consequence. By a very slight examination of the part, however, 
a dislocation of this kind may be detected; there is a very consid- 
erable projection of the bone backward, the thigh is drawn back, 
and the knee inclines inward, and is raised above its fellow-knee, so 
that the foot is raised from the ground ; the whole limb, too, is for 
a while immovably fixed. . Of the dislocation of this joint, there are 
four distinct forms, which we need not pause to describe : in each of 
them the reduction must be effected in the same way. Place the 
patient on a bed, with a strong towel, or sheet, passed between his 
legs and brought up round the hip ; let the ends of this be fastened 
to some firm support, such as a stout stick passed across a doorway ; 
then fix another towel to the thigh by means of a clove-hitch, and 
let three or four strong men take hold of the ends and keep up a 
steady strain for a quarter of an hour, or more if it be necessary ; 
the muscular power of the patient, if it be an adult, should have 
been previously weakened by bleeding, or tartar-emetic given in 
half-grain doses every ten minutes until nausea is produced ; this 
should be done in all cases of difficult reduction. The administra- 
tion of chloroform will have much the same effect,, and will likewise 
produce insensibility to pain. Sometimes, in such cases as these, a 
strap, with a pulley fixed to the wall, is used to effect the extension; 
most hospitals are furnished with this apparatus, and employ it con- 
stantly. 

As dislocation of the hip-joint is, sometimes confounded with 
fracture of the neck of the bone within the capsular ligament, and 
as great mischief might result from applying extension in such a 
case, it will be as well to observe that, in fracture, the knee and foot 
are turned outward — in dislocation, inward. 



292 THE CHAPTER OF ACCIDENTS. 

Dislocation of the Patella. — This is frequently produced by a 
person falling with the knee turned inward, and the foot outward ; 
it may be in either of three directions — outward, inward, or up- 
ward. The method of reduction is to place the patient on a bed, 
and, raising his leg by lifting it at the heel, press on the edge of the 
dislocated bone, which is farthest from the articulation, until the 
inner edge is raised over the crudella of the former, and is thence 
drawn into its place by the action of the muscles. Evaporating 
lotions should then be applied until the inflammation is subdued, 
when the part may be bandaged. When the dislocation is upward, 
the ligament of the patella is torn through, and in consequence there 
is generally a great deal of inflammation. Leeches are usually re- 
quired, and cold lotions for six or seven days, after which the leg 
must be kept suspended by a splint and rollers until a union of the 
ruptured ligament is effected. 

Dislocation of the Ankle- Joint. — This may be either inward, 
outward, or forward ; in the first case it may be the result of a jump 
from a considerable height, or sudden check of the foot when run- 
ning, the body by the impetus being carried forward. In the sec- 
ond, the foot is probably twisted in running or leaping ; or, it may 
be that the passing of the wheel of a carriage over the leg causes 
the injury. Jumping from a carriage in rapid motion, or falling 
backward with the foot confined, will probably cause the third form 
of displacement. Only a surgeon can detect the difference in these 
forms of knee-dislocation, and adopt the measures proper for their 
reduction ; there is great likelihood that they will occur again, hav- 
ing once happened, therefore it is best to keep the ankle bandaged 
or supported by means of an elastic stocking. 



DISEASES OP THE EYE AND EAR 



OPHTHALMIA. 

1. Mild or Catarrhal Inflammation. — The symptoms are redness 
of the surface of the eye, from fulness of the vessels of the outer coat, 
commonly called " bloodshot eye.; " pain and smarting, as if from 
particles of dust or sand in the eye ; swelling of the membrane on 
the surface of the eye, and inside of the lids. This form sometimes 
terminates by the formation of vesicles on the eye. 

2. Severe Inflammation (purulent ophthalmia). — The above 
symptoms are much aggravated, and attended with a profuse dis- 
charge of pus or matter from the surface of the eyes. Of this there 
are two forms — one belonging to infants, the other to adults. 

3. Scrofulous Inflammation. — In addition to the above symp- 
toms, there is intense intolerance of light ; the patients (generally 
children) hide their faces and keep their eyes shut, to avoid the pain 
that light causes. There is generally a profuse flow of tears. This 
form is very prone to cause ulceration of the cornea (the transparent 
membrane on the front of the eye), by which opaque spots are left 
and sight is impaired. 

4. Rheumatic Inflammation. — The eye is less bloodshot, but the 
pain is greater in the ball of the eye itself, and the bones around the 
eye ; there is intolerance of light, and the symptoms are more dis- 
tinctly remittent. 

5. Inflammation of the Cornea. — {The transparent membrane at 
the front of the eye, through which the light passes, is the cornea.) 
The cornea loses its transparency. Specks form on its surface ; a pink 
ring of inflammation forms around its edge ; at last the specks are 



294 DISEASES OF THE EYE AND EAR. 

seen to have "become small ulcers, which, sometimes perforating 
the membrane, let out the fluid from behind its inner surface. 

6. Inflammation of the Iris or Membrane which surrounds the 
Pupil. — This part loses its ordinary aspect, and becomes dull ; its 
freedom of movement is impaired; its border becomes irregular; 
the sight is dim ; there are pain, and other signs of inflammation, as 
mentioned above. 

7. Inflammation of the Internal Parts and whole Globe of the Eye. 
— Severe pain, deeply seated ; sense of distention of the globe of the 
eye ; loss of sight ; swelling of the eye ; high fever. 

Treatment. — It is not safe to venture far in domestic treatment 
of disorders of the eye/ A few general rules may be laid down, and, 
if the disease yields to the steps taken under these, as the simple 
forms nearly always will, it is very well. Otherwise consult, at any 
expense, the best oculist within reach. Warm bathing of the eye, 
combined with mercurial treatment, should first be tried in all the 
forms of ophthalmia ; if the habit of the patient is such as to bear 
this, five grains of blue-pill at night, and a saline or black draught 
in the morning, continued for three successive days, or alternate 
days, may be given ; if not, the mercury must be taken in a milder 
form, as in the gray powder, and combined with rhubarb, say three 
grains of the former, and eight or ten of the latter, every other 
night ; the diet should be low, and light excluded as much as pos- 
sible from the inflamed organ. Should the warm bathing not pro- 
duce a good effect, in a couple of days or so, use the following lo- 
tion: 

Tincture of opium, 1 drachm. 

Sulphate of zinc, . .8 grains. 

Acetate of lead, 16 grains. 

Rose or plain distilled water^ 8 ounces. 

Dip a piece of linen in this lotion, and bind it not too tightly 
over the eye, letting part of the fold hang down so as to cover it 
well ; keep this moistened. Should it be necessary to resort to other 
measures, drop into the eye, from a quill, or small glass tube, a so- 
lution of nitrate of silver, the strength about four grains to the 
ounce of distilled water, two or three drops three times a day, and 
apply leeches. When this disease continues long, the inflammation 
extends deeper, and it becomes chronic, in which case it has all the 
symptoms of the acute form of disease, except the feeling as of dust 
in the eyes ; the latter of the above measures will generally reduce it, 
or, should not the nitrate-of-silver drops succeed, use wine of opium 
alone in the same way, and a lotion made with green tea, and about 
one-sixth of its bulk of brandy, or other strong spirit. If, in spite 



OPHTHALMIA. 295 

of these remedies, the veins of the lids begin to swell on the out- 
side, showing that the inflammation is spreading, blisters should be 
applied behind the ears, and the system yet more reduced if this ap- 
pear safe. In this case there is a plan of treatment, which generally 
succeeds in giving relief, and it is really not so dangerous and formi- 
dable as it may seem. Let the lid of the affected eye be carefully 
closed, damp the outside with a sponge, then draw a stick of lunar 
caustic (nitrate of silver) gently and evenly across the moist sur- 
face in successive lines, taking care not to go over one part twice ; 
suffer the application to dry without opening the lid, which in a few 
hours will begin to swell, and soon attain such a size as to cause 
total blindness ; this may continue perhaps for a day or two, the 
cauterized surface during the time discharging a large quantity of 
serum ; the swelling will then gradually subside, and in a few days 
more, with the help of a dressing of simple ointment, the skin will 
have resumed its ordinary appearance, and all symptoms of inflam- 
mation will probably be gone. Gold-diggers and persons in similar 
circumstances, with whom ophthalmia is not uncommon, and who 
cannot command professional aid, will find this an effectual and easily- 
applied remedy. 

Purulent ophthalmia is rarely seen, except in new-born infants, 
in whom it is a result of inoculation from the maternal passages. 
Keep the eyes clean, and wash them with rose-water, in which are dis- 
solved three grains sulphate of zinc to the ounce. If the inflamma- 
tion is very active, a leech may be necessary to save the eye. 

Local applications will do little or nothing for the cure of 
scrofulous ophthalmia; the treatment must be general and gener- 
ous ; the cause is usually obstructed or unhealthy secretions, and, 
if these are rectified, the effect will soon disappear. Attention must 
be first paid to the state of the liver and kidneys • if these are defi- 
cient in action — if there is any thing wrong with the bile or the 
urine — administer the appropriate remedies. After this, administer 
tonics in combination with sedatives, say quinine, and digitalis ; or, 
if this affects the action of the heart too much, conium ; they may be 
given in the form of pills, one grain of the first and one-third of a 
grain of the second or third, three times a day. With some consti- 
tutions, the iodide of potassium acts best ; therefore, if the above 
does not succeed, take : 

Iodide of potassium, . . . / . .2 scruples. 

Compound essence of sarsaparilla, .... 4 drachms. 

Tincture of digitalis, or conium, 1 drachm. 

Cinnamon or mint water, 8 ounces. 

Take a tablespoonful twice a day. 
20 



296 DISEASES OF THE EYE AND EAR. 

It is sometimes advisable to add to this, sweet spirits of nitre, 
about a drachm. In obstinate cases, the pustules may be touched 
with nitrate of silver, but this should be done by a physician. 

Rheumatic inflammation of the eye will disappear under the 
treatment for acute rheumatism. 

For inflammation of the iris, give hydrargyrum iodidum viride, 
in pills of half a grain each, three times a day. 

Ulceration of the cornea, in its more dangerous form, is caused 
by extensive inflammation of the cornea itself; in its less dangerous 
form, by the little pustules associated with scrofulous ophthalmia. 
In the latter case, the treatment should be like that of strumous oph- 
thalmia ; in the former it cannot be too active and energetic, as there 
is little chance of saving the eye by other than the strongest meth- 
ods : calomel and opium, blisters, leeches, and the free use of the 
lancet, will no doubt be employed by the medical man, and no other 
can detect the niceties of the case sufficiently well to treat it properly. 

BLINDNESS {Amaurosis, Gutta Serena). 

In ascertaining the symptoms it is necessary that each eye be ex 
amined separately, and that while one is being examined the other 
should be carefully excluded from the light. The pupil is dilated, 
giving a staring look ; the eyeball either oscillates or has unusual 
fixity and prominence. The action of the pupil, when tried by a 
light brought to bear upon it, is sluggish or unequal, so it will have 
an irregular form. The irregularity in the shape of the pupil is most 
frequently seen toward the inner and upper side of the eye. 

Impairment of Vision. — The impairment of vision commences 
with black specks before the sight, flashes of light, pain in the fore- 
head and eyebrows. The failure of sight may, for some time, be 
partial, so that only portions of objects are seen. It may, at first, 
only be noticed at certain times of the day, or in the evening. These 
varieties are known as night-blindness or day-blindness. As the 
disease progresses, the impairment of vision becomes constant, and 
total blindness ensues. 

The distinguishing symptoms are those that separate amaurosis 
from cataract, and other diseases of the fluids of the eye. 

In cataract the dimness of vision is slower in its course, and has 
more the character of a mist or veil, than has that of amaurosis ; at 
the same time that in cataract an opacity is more or less plainly 
perceptible, filling the space of the pupil. 

In amaurosis depending upon insensibility of the retina, the pa- 
tient sees best at noonday ; the reverse takes place in cataract, which 
consists of opaqueness of the structures placed before the retina. 



CATARACT. 297 

The causes of this are, disease, or disorder of the brain, optic nerve, 
or retina. These may be permanent, depending upon change in the 
structure of the parts, or they may be connected with a merely tem- 
porary morbid condition, e. g., congestion, or poisonous substances 
circulating in the blood. Blows, or other injuries of the globe of the 
eye, protracted over-use of the organ with a strong light upon 
minute objects, or during the hours that should be given to sleep, 
are among the exciting causes. 

Treatment. — Attention to those conditions which may have 
given rise to it. If believed to be of a temporary character, active 
purgatives must be given, combined with mustard cataplasms to the 
nape of the neck, hot mustard-baths to the feet and legs, etc. 
Where the affection comes on suddenly, if medical advice can- 
not be spedily obtained, these means should be employed with- 
out loss of time, pending the arrival of the medical attendant. 

CATARACT. 

A disease of the eyes, producing opacity of the crystalline lens, 
which prevents the passage of the rays of light, and so causing 
blindness. The real cause of this disease is not well understood : 
it may proceed from external violence ; but more commonly it has 
some internal and occult origin ; it is of slow growth, and can only 
be operated on at a certain stage, when the opaque body in the pupil 
has assumed a sufficient density. 

The symptoms of its formation are, a dimness and mistiness of 
vision, which may generally be noticed before any opacity can be 
perceived on the lens itself; then there are optical illusions, like 
specks or motes floating before the eye; these are succeeded by the 
gradual falling, as it were, of a curtain upon the outward view, 
which is finally obscured altogether. Sometimes the progress of the 
disease is slow and gradual, but frequently it is rapid, especially in 
the latter stages ; persons who have passed the middle age are most 
likely to be affected by it, and sometimes it has made considerable 
progress in one eye before the patient is made aware of it by some 
accidental circumstance, which for a time prevents the use of the 
other. 

The proper treatment is depletion, where it can be borne ; cupping 
in the neck, blisters, or a seton ; repeated doses of calomel, with 
purgatives ; poultices of fresh hemlock-leaves constantly applied to 
the eye, or the extract of hemlock smeared around it, or a solution 
of the same dropped in. All remedies, however, generally fail, and 
an operation is necessary to save the sight. This is generally suc- 
cessful for a time, but very often the disease renews the attack after 



298 DISEASES OF THE EYE AND EAR. 

a while. A cataract may be either firm or hard, millcy or fluid, 
caseous or soft. In the first case the opaque lens retains a tolerable 
degree of firmness ; in the second the substance is converted into a 
whitish kind of fluid; and, in the third, it has a jelly or curd like 
consistence. 

Cataract is distinguished from gutta serena by the presence of 
sensibility to light, and the obvious opacity in the crystalline lens, 
neither of which is a symptom of the latter disease. 

GLASSES. 

Common low-priced spectacles, made as it were by chance, and 
from all sorts of defective materials, even sometimes from the com- 
monest window-glass, are not only useless to the wearer, but actually 
increase the evil they are intended to remedy. In these spectacles, 
the assortment of the lenses is irregular, one of the glasses having 
generally a different focus from the other ; they are, besides, badly 
polished, by which their transparency is affected ; they are almost 
always of different thickness; they are often full of specks and 
imperfections, which, being partially ground down, are not readily 
detected by the eye ; and finally, the convexity of the two glasses is 
seldom equal, the sides not only differing, but different degrees of 
convexity even existing on the same side of each lens. 

The cheapness of these glasses, unfortunately, is a bait to many 
— but the saving of a few cents ought not, in any instance, to be put 
in competition with the preservation of one of the most important of 
our senses. Many persons with defective vision, with proper glasses, 
have for the space of ten, nay, even twenty years, preserved the 
same degree and extent of sight they first obtained from their use 
— an advantage which they could not have enjoyed had they adopt- 
ed the badly-manufactured glasses to which we have alluded. 

Spectacles, the lejises of which have different degrees of convexity 
or concavity, can never represent objects correctly, or of their 
natural form and colors, but cause them to appear distorted, and 
tinged with refracted rays of light along their outlines. This pro- 
duces in the eye a kind of attraction, or drawing forward; the 
oblique muscles of the eye being obliged to lengthen themselves in 
order to see an object distinctly. 

The inequality of their focal distances produces, also, strange 
confusion : a common glass will sometimes have a focal distance of 
twelve inches at the centre, and only ten at the circumference ; be- 
sides which, this will often be found associated with another glass, 
whose central focus is but ten inches, and that of the circumfer- 



DEAFNESS. 299 

ence perhaps fourteen. From this it is easy to imagine what injury- 
must be done to weak eyes, but whose powers are equal, when thus 
obliged to change the diameter of the pupil, and to admit a 
greater or less amount of light at every instant. 



DEAFNESS. 

Deafness may proceed from any injury inflicted on the delicate 
organs of the ear by loud noises, violent colds, inflammation or 
ulceration of the membrane of the auditory passages ; hard wax, or 
other substances interrupting the transmission of sounds ; either 
overdryness or excessive moisture in the parts ; want of tone in the 
general system from debility ; among one of its frequent causes is 
some defect in the structure of the organ itself, which no medical 
treatment can obviate ; in this case there is generally dumbness as 
well. 

The treatment will depend to a considerable extent on the cause. 
If there is an accumulation of hardened wax, or any defective or dis- 
eased action in the glands secreting that substance, a few drops 
of a saturated solution of common salt, or of ox-gall and balsam of 
tolu, one part of the former to three of the latter, may be dropped 
into the ear, while the head is held on one side, night and morning ; 
or applied on a piece of wadding inserted by means of a probe. Be- 
fore each application, the ear should be syringed out with warm 
milk-and-water, or soap and water. If there is a thin acrid discharge 
accompanying the deafness, apply a blister behind the ear, and keep 
it open for some time with savine ointment. When deafness pro- 
ceeds from cold in the head, diaphoretics, the warm foot-bath, and 
flannel wrappers, must be the remedies ; if from debility and conse- 
quent loss of tone, drop stimulants into the ear, electrify or galvan- 
ize, and give tonics ; this will be the treatment also, if it proceeds 
from defective energy of the optic nerve. 

Sulphuric ether has been declared to be very efficacious in the 
cure of deafness. From four to eight drops are to be daily dropped 
into ,each ear of children, and double the quantity into the ears of 
adults. 

Glycerine has been very strongly recommended for that particu- 
lar kind of deafness arising from a thickening of the passage {mea- 
tus) down to the tympanum, or drum of the ear. In this case there 
is a greater or less degree of deafness, corresponding with the amount 
of thickening ; cessation of the secretion of wax ; and frequently 
singing or hissing in the ears. In applying the glycerine, the 
meatus or external opening of the ear is to be well cleansed with 



300 DISEASES OF THE EYE AND EAR. 

tepid water by means of cotton used with the forceps. The glycer- 
ine is then poured into the ear, and a plug of gutta-percha, softened 
in boiling water, made to fit the external opening ; this takes the 
exact form of the ear, becomes hard, and effectually prevents either 
the entrance of atmospheric air or the exit of the glycerine. The 
ear should be examined daily, and the same process repeated. The 
lining membrane can be examined with a blunt silver probe, passed 
gently through the speculum auris, to ascertain the effect of the 
glycerine upon the articular thickening. The meatus, or opening, 
will gradually lose its shining, pearly appearance, and softened pieces 
will fall off, and can be removed either by the forceps, or gently 
syringing. Never attempt to tear them away, but allow them to 
come away by the means just stated. The treatment occupies 
ordinarily from two to four weeks, and is generally without pain or 
inconvenience of any kind to the patient. 

Ear-diseases are not so easily determined as those of many other 
organs, on account of their greater concealment. Delicate and scro- 
fulous children are especially liable to a yellow discharge, which sud- 
denly comes on, and is at first often stained with blood, and accom- 
panied by feverishness and great pain in the parts ; there are general- 
ly redness and swelling of the passages of the meatus, and inflam- 
mation of the surrounding skin. This may arise from an inflamed 
state of the membrane which lines the passages, or from an abscess 
formed beneath it, or between the cells of the bones of the mastoid 
process. The discharge may be caused by some foreign substance 
thrust into the ear, such as a bead, pea, or piece of slate-pencil ; in 
this case great care must be exercised in attempting to remove the 
foreign body. Very commonly this fills the whole cavity, so that 
it is difficult to insert any instrument between, and the danger is 
that it may be pushed so far in as to press upon the tympanum, caus- 
ing inflammation and acute pain ; sometimes the efforts to effect the 
removal result in the displacement and bringing away some of the 
small bones ; while the object whose removal is attempted is prob- 
ably pushed into a position from whence only an operation will ex- 
tract it. A pair of fine forceps in the hands of a skilful surgeon 
will probably effect the desired object, or it may be done by a care- 
ful mother or nurse by means of an ear-pick; but it is best for 
such to have recourse to a syringe and warm water, taking care to 
throw the water in gently, and leave plenty of room for its return 
through the orifice of the ear. If these efforts are unsuccessful, it 
is best to let the foreign body remain for a day or two, it will most 
likely cause an enlargement of the orifice, and become coated with 
wax, which will render it less irritating to the membrane, and also 



DEAFNESS. 301 

facilitate its removal ; from time to time the syringing should be 
continued, and this will no doubt eventually effect the removal. A 
piece of slate-pencil is one of the most frequent as well as danger- 
ous substances which can be introduced into the ear, as, on account 
of its angular form, it is very difficult of extraction, and likely to 
cause irritation ; a pin or a needle is also bad, the latter especially, 
as it is likely to make its way into the intricate parts, and cause se- 
rious temporary if not permanent mischief; either of these, how- 
ever, if its insertion be known of in time, can generally be taken 
out by means of forceps. 

For the purulent discharge from the ear, which is induced by 
this or any other cause, a lotion, made with two drachms of solution 
of chlorinated soda to six ounces of rose or elder-flower water, 
should be injected, but not with any force ; the best method is to 
let it flow into the ear, held so as to receive it fairly, from a small 
sponge saturated with the lotion. 

As children sometimes fancy things have got into the ear when 
they really have not, it is best to institute an examination before 
attempting their removal ; this may be done by drawing the upper 
lobe of the ear upward and backward, which will have the effect of 
straightening the curved passage so that the eye can discern the 
drum at the bottom, unless there is an interposing object. 

Counter-irritation will sometimes have a good effect on purulent 
discharges from scrofula or other causes ; a small blister behind the 
ear is the best application, but it should not be kept open for any 
length of time, or it will weaken the system too much. When the 
discharge is the result of active inflammation, and is attended by 
febrile symptoms, a spare diet and aperients must be the treatment ; 
but weakly, scrofulous systems require a generous diet and tonic 
medicines. 

Earache may proceed from abscess in one or more of the pas- 
sages, or it may be altogether neuralgic. In children it is not un- 
common during the period of dentition, and is especially severe in 
cutting the permanent teeth ; grown persons sometimes suffer from 
it when producing their wisdom teeth ; it is often brought on by 
exposure to cold or draughts ; there is not often much constitutional 
derangement, although the pain is sometimes excruciating, unless it 
is long continued. 

Treatment. — In children, during dentition, lancing the swollen 
gums will often afford relief, especially if an aperient be given, such 
as rhubarb and magnesia combined with a little ginger, as in 
Gregory's powder; elder children may have a little laudanum 
dropped into the ear, and take compound senna mixture, repeated 



302 DISEASES OF THE EYE AND EAR. 

until the bowels are freely opened ; should these remedies not prove 
effectual, a fomentation of chamomiles and poppies should be applied, 
and a warm poultice afterward ; the heart of a roasted onion applied 
warm to the external orifice will sometimes afford relief. If the 
case is very obstinate, two or three leeches behind the ear, followed 
by a blister, may be tried, with an anodyne saline aperient some- 
thing like this : 

Acetate of morphine, ....... £ grain. 

Solution of acetate of ammonia, ...... 3 ounces. 

Sulphate of magnesia, 1 ounce. 

Water or camphor mixture, . . . . . .5 ounces. 

Mix, and take two tablespoonfuls every four hours. 

When earache is caused by an abscess, and is attended with 
much swelling and severe pain, hot fomentations and poultices will 
be the treatment, syringing the external passage with warm water, 
and, after the abscess has discharged, with a solution of sulphate 
of zinc, in the proportion of eight grains to the ounce of plain or 
rose water, attention being paid to the bowels. With some persons 
any derangement of the general health will cause the formation of 
these abscesses, and in such cases the treatment must be rather gen- 
eral than local. Earache, no doubt, often proceeds from derange- 
ment of the digestive organs, and may be relieved by active purga- 
tives and emetics. When it is strictly neuralgic, quinine, or some 
preparation of iron, will be the most appropriate remedy, with stim- 
ulating liniments rubbed in behind and about the ear. 



MIDWIFEEY. 



MENSTRUATION. 



This is a function of the uterus, by which the monthly discharges 
take place. These generally commence between the fourteenth and 
sixteenth years of age, although they may begin as early as eleven 
or twelve. A considerable period may elapse between the appear- 
ance of the first and second menstrual discharge ; but, when they 
are properly established, their recurrence at regular periods may be 
calculated on with great certainty, unless some functional or other 
derangement of the system interferes with them. Ordinarily a lunar 
month of twenty-eight days is the intervening period, but with some 
females the discharge occurs every third week ; the fluid discharged 
is partly blood, which, owing to mixture with other fluids, does not 
coagulate ; the quantity is from three to five ounces, and the pro- 
cess occupies from three to five days. The quantity, however, and 
duration of the emission vary greatly in different females, and, 
unless the former is either very scanty or excessive, these do not 
appear important particulars ; but the regular recurrence of the issue 
is important to health ; this should be borne in mind, and due care 
taken not to suppress the discharge by exposure to cold or wet, 
or by violent exertion of any kind about the time when it may be 
expected. It is desirable that young females should be properly 
informed by their mothers, or those under whose care they are 
placed, of what may be expected at a certain age, or they may be 
alarmed at the first appearance of the menses, taking it to be some in- 
dication of a dangerous disease or injury, and, perhaps, by mental agi- 
tation or a resort to strong medicines, do mischief to themselves. If 
the menses do not appear at the usual age, or for some years after, 
no alarm need be felt, provided there is no constitutional derange- 
ment which can be attributed to this cause. Some women never 
menstruate, although they may be married and have a family. 



304: MIDWIFERY. 

The disorders of this function are : suppression of the menses ; 
dysmenorrhea, or painful menstruation ; and menorrhagia, or pro- 
fuse menstruation. 

SUPPRESSION OF THE MENSES. 

Sudden suppression of the menses may arise from exposure to cold 
or wet, from extreme mental distress, and several other causes ; it is 
generally accompanied by violent headache, severe pain in the loins 
and abdomen, difficulty of breathing, and shivering. In this case 
the patient must take warm diluent drinks, saline aperients, till the 
bowels are freely opened, have hot bran poultices applieid to the 
lower part of the abdomen, immerse the feet and legs in hot water, 
rendered stimulant by the addition of mustard ; if the pain is ex- 
treme, take an opiate draught every four hours, and have a lave- 
ment, with one drachm of turpentine and half a drachm of tincture 
of opium thrown up ; she must also be kept as quiet as possible. 

Chronic suppression may result from the acute, or from defect- 
ive nutrition of the organs ; from the early termination of menstrual 
functions, or from the weakness occasioned by a profuse discharge 
of " whites." In this case we generally have pains in the head, 
sides, and back, loss of appetite, giddiness, sallow complexion, 
with a dark line around the eyes, generally torpid bowels, with 
other dyspeptic symptoms. It is sometimes difficult to distin- 
guish between this and the early stage of pregnancy; in both we 
have a large abdomen, but in the latter usually the breasts are flat, 
in the former full and plump, but the doubt will not long remain ; 
the morning sickness, the increasing size of the abdomen, and the 
other unmistakable signs of pregnancy, will appear in the one case, 
or not in the other, and thus give an easy means of distinction. 

In this case, the warm hip-bath should be used about the proper 
period of menstruation, and it would be well to give some uterine 
stimulant, such as ergot of rye, of which about five grains, with two 
grains of aloes, and a drop of essential oil of juniper, made into two 
pills, or mixed up in a powder, would be about the dose to be taken 
each night at bedtime, with a draught of pennyroyal-water ; or a 
mixture composed of spirits of turpentine, made into an emulsion 
with yolk of egg, sugar, and essence of juniper, about six drachms 
of the first and one of the last, in a six-ounce mixture ; one ounce to 
be taken three times a day. These means of promoting the dis- 
charge in any case must not be prolonged much beyond the men- 
strual periods, between which all possible means must be taken to 
strengthen the system ; good diet, plenty of active exercise, the use 
of the shower-bath, or cold or tepid sponging ; steel mixture, with 



PROFUSE MENSTRUATION. 305 

aloes and iodine, in one or other of its forms ; these are the proper 
remedies. 

Painful menstruation is the rule with some females, but the ex- 
ception with most ; it does not seem to be in any way connected 
with the quantity of the discharge, and it may attend both the 
secretion and the emission ; or but one or other of the processes, 
and but partially, coming on in paroxysms, or continually, during 
the whole process ; the matter discharged is often thick and mem- 
branous, and sometimes has in it clots and streaks of blood : the 
cause of this is not very clear ; it has been observed to occur after 
strong mental emotions, a cold caught during the menstrual period, 
a fright or other shock to the system, and would seem to indicate 
an irritable state of the womb. In this case we must resort to 
warm hip-baths and friction, fomentation of the parts, diluent 
drinks, saline aperients, opiates, and a spare diet. 

As a local means, perhaps the most useful palliative is the appli- 
cation of warmth to the region of the womb, and over the whole 
surface of the abdomen, by means of hot water. Warmth may also 
be applied at the same time to the feet. And the injection of warm 
water into the womb is sometimes useful. 

From twenty to sixty drops of the ammoniated tincture of guai- 
acum should be given twice a day. 

PROFUSE MENSTRUATION {Menorrhagia). 

The periods return at short intervals, and the discharge is too 
profuse, and lasts too long. The usual duration of the period is 
four or five days ; the quantity of blood lost is, on an average, about 
five ounces. Much more than this is excessive. The blood is some- 
times discharged in gushes, and mixed with clots, so that if it occur 
in married women it is not always easy to distinguish it from early 
miscarriage. In the intervals a discharge of whites is constant. 
The patient becomes debilitated and pale, suffering from headache, 
faintness, feebleness of pulse, palpitation, ringing in the ears, disor- 
ders of the stomach and bowels, nervous affections, swelling of the 
feet and legs; pain, and sense of weight or bearing down in the 
region of the womb. 

The causes are : Hemorrhagic tendency ; the period of the ces- 
sation of menstruation ; debilitated constitution ; irritating violent 
purgatives ; unusual bodily exertions j mental or moral excitement ; 
indolent and luxurious habits of life. 

Tkeatmeist. — Absolute rest ; lying on a mattress or cool couch ; 
taking all food and beverages cold ; application of cloths dipped in 



306 MIDWIFERY. 

cold water to the lower part of the body ; saline aperients, with 
mineral acids. If these do not suffice to moderate the discharge, 
acetate of lead or sulphate of zinc should be given, or a mixture of 
the sulphate of quinine, as follows : 

Sulphate of quinine, . 16 grains. 

Water, 2 ounces. 

Sulphuric acid, • ■£■ drachm. 

Take a teaspoonful once in four hours. 

Or give once an hour, for two or three successive hours, ten 
drops of the tincture of digitalis. 

In the intervals, steel and other tonics and aperients, together 
with a liberal diet, should be taken. 



LEUCORRH(EA, OR WHITES. 

Usually this troublesome affection is associated with general 
debility, especially if it has continued profuse for any length of 
time ; hence it is very desirable that attention should be paid to it 
at the commencement ; for, if neglected, it may seriously impair the 
constitution, and grow from a comparatively mild affection into an 
inveterate habit of the system. 

The causes of this discharge are over-exertion of the uterine or- 
gans, irritation of the rectum from loaded and constipated bowels ; 
it may also be brought on by diarrhoea, piles, worms, irritation of 
the bladder, or of the nervous system ; weakness, too, is a cause, as 
well as a consequence, of its long continuance ; confinement in a 
warm atmosphere, and luxurious living, must likewise be numbered 
among its exciting causes. 

We can generally distinguish this disease from gonorrhoea, by 
the absence of local irritation and swelling of the external parts, and 
the glands of the groin ; also by the discharge being less regular 
and copious. 

In leucorrhcea, the discharge is commonly at first white and pel- 
lucid ; or it may be opaque, and thick, coming away now and then 
in lumps ; after a while the Color wili^erhaps change to green, yel- 
low, or brown, and sometimes it will become very acrid, causing 
abrasion and smarting on passing the urine. In this stage it is apt, 
especially during pregnancy, to cause a gleety discharge from the 
urethra of one having sexual intercourse with the patient. Ere long, 
if the disease is not checked, we get great local irritation, and con- 
stitutional disturbances; there will probably be costive .bowels, 
pains in the loins and back, great lassitude, with nervous and hys- 



LEUCORRHCEA, OR WHITES. 307 

terical affections. Menstruation, too, will be irregular, at one time 
being altogether suspended, and at another too abundant. 

Treatment. — Women, who are likely to have leucorrhoea, should 
avoid all predisposing causes of the disease ; such are wines and other 
stimulants, and hot tea or similar drinks taken in large quantities ; 
luxurious living and sensual indulgences of all kinds, especially- 
much sexual intercourse, and any thing which has a tendency to 
enervate and enfeeble the frame. Early rising and regular open-air 
exercise are essential. 

The cold hip-bath should be used twice or thrice a week. Some 
very delicate women will find the most advantage from the tepid 
bath at about 86°. Lime-water should be taken as common 
drink, or in the quantity of a pint a day, in divided doses ; and a 
blister may be applied to the sacrum, or broad bone at the bottom 
of the spine, and occasionally repeated. Whatever the general plan 
of treatment may be, the lime-water and blisters are almost always 
applicable, and more or less serviceable. So, also, is the common 
use of some bitter tonic, as the tincture of gentian, cinchona, or ca- 
lumba. 

Generally speaking, the principal object to be aimed at is to 
give firmness to the general habit, and strength to the weakened 
and relaxed membranes of the womb and its passage, by the em- 
ployment of vegetable and metallic tonics, or stimulants, vegetable 
alteratives, cold bathing, astringent injections, pure air, and suffi- 
cient exercise, aided by a mild but nutritious diet. 

Costiveness must be prevented, by the regular use of a mild ape- 
rient, as rhubarb. Indigestion and irregular menstruation must be 
equally guarded against. 

In obstinate cases, there should be an injection into the vagina 
of a solution of alum and sulphate of zinc, three drachms of the for- 
mer, and one drachm of the latter, to a pint of water ; three or four 
ounces to be thrown up, while the patient lies with the hips rather 
elevated ; this position to be retained for some time, with the parts 
covered by a napkin or sponge, so that the fluid may be kept in. 
If there are itching and irritation of the parts, they may be allayed by 
an injection composed of carbonate of soda, two drachms, in a quart 
of bran-tea or poppy-decoction. If the simple alum-and-zinc injec- 
tion proves ineffectual, add a drachm of powdered catechu to each 
pint, or use decoction of oak-bark as a vehicle. 2jv the above salts. 

An effective injection, when the discharge is offensive, is the pro- 
portion of one drachm to one ounce of water. 

Balsam of copaiba is directly curative of the disease in many 
cases. Although it is a revolting measure to most persons, there is 



308 MIDWIFERY. 

an astonishingly curative effect in injecting into the vagina, imme- 
diately it is voided, the person's own urine, passed while she is tak- 
ing copaiba. 



CHLOROSIS, OR GREEN SICKNESS. 

This occurs in young girls suffering from some irregularity 
or disorder of the menstrual function. It is characterized ' by a 
pale, blanched complexion, languor, listlessness, and depraved ap- 
petite and digestion ; the several secretions being faulty or inert, 
especially at the commencement. The languor extends over the 
whole system, and affects the mind as well as the body; and 
hence, while the appetite is feeble and capricious, and shows a 
desire for the most unaccountable and innutrient substances, as 
lime, chalk, etc., the mind is capricious and variable, often pleased 
with trifles, and incapable of fixing on any serious pursuit. The 
heat of the system is diffused irregularly, and is almost always 
below the point of health; there is, consequently, great general 
inactivity, and particularly in the small vessels and extreme parts 
of the body. In advanced cases, the pulse is quick and low, the 
breathing attended with labor, the sleep disturbed, the face pale, 
the feet cold and swollen, the nostrils dry, the bowels irregularly 
confined, and the urine colorless. 

Treatment. — The great object of treatment is, to get the sys- 
tem into a state of good general health, and to improve the quality 
of the blood, by the use of tonics, alteratives, and aperients; in 
conjunction with horse-exercise, change of air and scene, a moderate 
but very nutritious diet, and cheerful society. Let the following be 
taken : 

Sulphate of iron, 20 grains. 

Socotrine aloes, 3 grains. 

Ipecacuanha, in powder, . . . . . . 3 grains. 

Aromatic powder, . 6 grains. 

Extract of gentian, 2 scruples. 

Mix, and, with a little syrup, make the whole into a mass, to be divided into 
twenty pills. Two to be taken three times a day, after every meal. 

The sulphate of iron may be increased each time the pills are 
prepared, until the above quantity is doubled. 

Or give pills of the carbonate of iron, made in Valet's mass, from 
twenty to thirty grains a day. 



PREGNANCY. 



309 



PREGNANCY. 

The period from the time of conception to that of delivery should 
be forty weeks, or 280 days. It is commonly set down as nine cal- 
endar months, but this would make only 275 days; or, if February 
be included, 272 or 273 days, that is, 39 weeks only instead of 40, 
or nine calendar months and a week. In making the necessary pro- 
vision for the coming on of labor, it is best to calculate from mid- 
way between the last occurrence of menstruation and the one which 
would have followed, if conception had not taken place, and allow 
nine calendar months from that time. 

The following table will be found useful in counting the proba- 
ble time of delivery : 



Nine Calendar Months. 


Ten Lunar Months. 


From 


To 


Days 


To 


Days 


January 1 


September 30 


273 


October 7 


280 


February 1 


October 31 


273 


November 7 


280 


March 1 


November 30 


275 


December 5 


280 


April 1 


December 31 


275 


January 5 


280 


May 1 


January 31 


276 


February 4 


280 


June 1 


February 28 


273 


March 7 


280 


July 1 


March 31 


274 


April 6 


280 


August 1 


April 30 


273 


May 7 


280 


September 1 


May 31 


273 


June 7 


280 


October 1 


June 30 


273 


July 7 


280 


November 1 


July 31 


27'3 


August 7 


280 


December 1 


August 31 


274 


September 6 


280 



310 MIDWIFERY. 

This table may be thus illustrated: A woman has ceased to 
menstruate on the 1st of July; her confinement may be expected at 
soonest about the 31st of March (the end of nine calendar months), 
or at latest about the 6th of April (the end of ten lunar months). 
Another has ceased to menstruate on the 20th of January ; her con- 
finement may be expected twenty days after the 30th of September 
(the end of nine calendar months) at soonest, or twenty days after 
the 7th of October (the end of ten lunar months) at latest. 

The chief signs of pregnancy are : 1. The cessation of the menses ; 
although this is by no means an unfailing sign, for sometimes this 
discharge will cease from other causes, and sometimes it will con- 
tinue after conception has taken place. 2. Morning sickness, which 
generally commences about the fourth or fifth week, and lasts to 
about the fourth month ; with some this is but slight, and causes 
but little inconvenience ; but with others it is more continuous and 
serious, sometimes causing the rejection of nearly all food for a 
very considerable period. This symptom, again, cannot be taken 
as a proof of pregnancy ; it is merely a suspicious circumstance, to 
be watched in connection with others. 3. Enlargement of the 
breasts, which generally increase in size about two months after 
conception ; they also become tender and sore, they throb and burn, 
and, when pressed by the hand, have a hard, knotty feel, in conse- 
quence of the swelling of the glands by which the lacteal fluid is 
secreted. The nipple also becomes more prominent, and increases 
in diameter, while the areola around it assumes a purplish tinge, and 
has on it several little raised pimples of a yellowish-white color. 4. 
Enlargement of the womb and abdomen, which, in the fourth month, 
becomes very perceptible ; the womb, which may now be felt in a 
firm rounded body, having ascended above the bone of the pubes, 
and pushed the bowels up into the abdomen. 5. A tendency to 
flatulent distention of the stomach, toward evening especially, ren- 
dering insupportable a pressure of stays, etc., which in the morning 
could be easily borne. 6. " Quickening," which is the mother's first 
perception of the second life within her ; there is at first, probably, 
a very slight tremulous motion, like a mere pulsation ; this, day by 
day, grows stronger, until it becomes quite distinct — often painfully 
so. There are other and less obvious signs, which only the profes- 
sional man would be likely to detect ; all may notice, however, the 
change which generally takes place in the countenance ; the mouth 
and eyes seem to enlarge, and the nose becomes what is generally 
termed more or less pinched up ; there is an alteration, too, in the 
color of the eyes, which become somewhat paler ; especially is this 
perceptible if they are blue eyes. Then, the patient is generally 



PREGNANCY. 311 

fidgety, peevish, and restless, exhibiting a high degree of nervous 
irritation; she has odd fancies, and longings after out-of-the-way 
things and articles of diet, which should be procured for her if pos- 
sible. At such a time she requires soothing and humoring ; harsh 
and unkind treatment will be likely to have a most injurious effect, 
both upon her and her offspring. 

Touching the disorders to which pregnant women are liable, 
local and general, we may observe, in addition to those already 
mentioned above, that a varicose condition of the veins of the legs 
is one of the most common; it usually occurs during the latter 
months of pregnancy, and arises from the pressure on the trunk 
veins in the pelvis. This is sometimes very painful and distressing, 
the veins becoming very dark-colored and swollen, and often perma- 
nently varicose, so that an elastic stocking, which is at first put on 
to afford temporary relief, has to be always worn. 

Constipation during the latter months of pregnancy is nearly 
always present, the pressure upon the lower bowel being the cause. 
Neither aloes nor any violent cathartic should be taken. A moder- 
ate dose of castor-oil may be administered about every other day, 
or as often as necessary. Piles are often very troublesome to preg- 
nant women. 

Cramp is also sometimes very violent and troublesome; it is 
confined to the lower limbs, and occasioned by the pressure of the 
enlarged womb upon the nerves ; there is also often great irritability 
of the bladder, and violent headache. 

The troubles peculiar to pregnancy should be managed, rather 
than actively treated, and always with a view to the end. Remem- 
ber that they are mainly a necessary consequence of a condition 
that can be completely changed only in nine months. Delivery will 
cure . them all, and nothing else can effectively do so ; therefore, 
worry along. Every dose of medicine given to a pregnant woman 
has an ill effect on her child. 

" A pregnant woman," says Montgomery, " should be made 
aware that the advantages obtained by well-regulated habits are by 
no means exclusively conferred on her, but that others equally im- 
portant" are likewise conferred on the child, for whom a larger supply 
of nutrition, and of .a better quality, will thus be provided ; and so, 
being nourished by sound and healthy fluids, will commence its 
career of life strong, vigorous, and less liable to those morbid debil- 
ities and derangements which affect the children of the indolent, 
the pampered, or the debauched." The mother in expectancy should 
oear this in mind, and, not only for her own sake, but for that of the 
being in embryo, on whose future health and destiny she will exer- 
21 



312 MIDWIFERY. 

cise so great an influence, let her avoid all unnecessary causes of 
excitement, all undue fatigue and exposure to weather ; let her lead 
a quiet, regular life ; take good, nourishing diet, but not rich and 
luxurious. It is a mistake to suppose that more food is required 
during pregnancy than at any other time ; the stomach then par- 
takes of the irritability of the whole system, and to overload it, as 
is frequently done, is sure to increase, if it does not cause, the sick- 
ness to which we have alluded as one of the symptoms of pregnancy. 
Therefore, let the eating and drinking be moderate, and let modera- 
tion, too, be the rule in all the pleasures and enjoyments of the 
senses. No woman who is in the family way should, if she can 
possibly avoid it, witness a scene of deep distress, or acute suffering ; 
or read or listen to any fearful and harrowing recital ; her nervous 
system is in a state of extreme impressibility, and neither the feel- 
ings nor the imagination should be unnecessarily excited ; if they 
are, the mind is likely at such a time to lose its balance, or a preju- 
dicial effect may be produced on the child yet unborn. 

There is a condition of the female system, called spurious preg- 
nancy, that leads often to peculiar delusions. It is most frequently 
observed about the turn of life, when the catamenia, becoming 
irregular, previous to their final cessation, are suppressed for a few 
periods, and at the same time, the stomach being out of order, 
nausea or vomiting is experienced, the breasts enlarge, become 
sensible, or even slightly painful, and sometimes a serous fluid 
exudes from the nipples and orifices of the areolar tubercles ; the 
abdomen grows fuller and more prominent, especially in women of 
full habit, and constitutionally disposed to embonpoint, and the 
abdominal enlargement progressively increases, partly from depo- 
sition of fat in the integuments and in the omentum, but still more 
from distention of the intestines by flatus, which, passing from one 
part to another, communicates a sensation like that produced by the 
motion of a foetus. The nervous system is generally much dis- 
turbed, and the woman feels convinced that she is pregnant, an idea 
which, at the time of life alluded to, is cherished by the sex with an 
extraordinary devotion, and relinquished with proportionate reluc- 
tance ; and not unfrequently, at the end of the supposed gestation, 
the delusion is rendered complete, and almost assumes the character 
of a reality, by the occurrence of periodical pains strongly resem- 
bling labor. 

ACCIDENTS OF PREGNANCY. 

These are abortion, or miscarriage, and premature birth. All 
these names mean a discharge of the contents of the womb before 



ABORTION. ■ 313 

the full term ; but abortion and miscarriage are applied to this dis- 
charge when it takes place so early in pregnancy that the foetus 
cannot live, and premature birth is applied to the same occurrence 
when not inconsistent with the life of the child — that is, when it 
takes place at any time between the seventh and ninth month. It 
has been said that a child born in the fifth month has lived ; it is 
very doubtful, and the seventh month is better regarded as the ear- 
liest possible date. 

ABORTION. 

Abortion, or miscarriage, as it is more commonly termed, may 
proceed from various causes, such as a sudden shock to the system 
by a fall or fright, straining, or overreaching ; the administration 
of strong purgatives or emetics, excessive indulgence in venery, or 
aught which may tend to debilitate the system ; malformation of 
the generative organs ; fevers and severe inflammations ; syphilis, 
or constitutional disease of any kind; the growth of polypi or tu- 
mors in the cavity of the nterus, or adhesion to the surrounding 
viscera ; too great contractility of the uterine fibres and blood- 
vessels ; most frequently, perhaps, it is a diseased condition of the 
foetus itself, which, wanting the elements of growth and vitality, is 
rejected as a useless and troublesome incumbrance. Two classes 
of females, very different in constitution and appearance, are more 
than commonly liable to abortion, viz., those of a voluptuous and 
plethoric habit, and those of a weak and irritable frame. For obvi- 
ous reasons, it is more common for women of the lower orders to 
miscarry than those of the middle and upper classes ; those who 
continue to suckle after conception has again taken place render 
themselves liable to it, because a certain amount of nutriment re- 
quired by the foetus goes to the formation of the milk. 

Pains in the lower part of the abdomen, in the loins and hips, 
occurring most frequently at about the second or third monthly 
period after suppression has occurred, are the premonitory or threat- 
ening symptoms. They may pass off as such, or they may be fol- 
lowed by a discharge of blood, either in considerable quantities or 
sometimes not exceeding the flow in ordinary menstruation. From 
the latter it may be distinguished by the character of the pain, 
which is expulsive and bearing down, and by the color of the dis- 
charge, which is bright. The absolute occurrence of abortion can 
only be determined by the discovery of the conception (the ovum) ; 
it is, therefore, a point of importance, where miscarriage is suspected, 
not to throw away the discharges without careful examination. At 
the earliest stages of its existence, the ovum is a small, colorless 



314 MIDWIFERY. 

bladder, about the size of a hazel-nut or walnut, containing a trans- 
parent fluid. At later periods the ovum, being larger, is not so 
easily overlooked, unless it has been ruptured ; but even then the 
partially-developed child will be discoverable. 

Treatment. — Attention to the general health, and the observ- 
ance of all means for strengthening the system, will tend to prevent 
this accident. Particular care to be taken as the period approaches 
at which this occurrence may be anticipated. At this time it is 
advisable that the patient should sleep alone, and upon a mattress. 
Gentle exercise ; rest on a sofa as much as possible. 

For the symptoms of threatened miscarriage, the patient should 
go to bed (if on a mattress, so much the better) ; the room should 
be freely ventilated and kept cool ; the diet should be light and 
unstimulating. From fifteen to twenty drops of laudanum, accord- 
ing to the severity of the pain, may be given, and repeated, if re- 
quired, in three or four hours. A dose of castor-oil or epsom salts 
should be taken in six or eight hours afterward. 

If these precautions have not been taken, or have not availed, 
the patient should be laid on a bed, lightly covered, the room kept 
cool, and the haemorrhage checked by the application of napkins, 
dipped in cold water, to the lower part of the body. The profuse 
discharge which takes place may sometimes be checked by plugging 
with a cambric handkerchief, or piece of sponge dipped in cold 
water. 

PREMATURE BIRTH. 

This is an accident to be most carefully guarded against, for a 
child born before its regular time can scarcely be expected to have 
the strength and vigor of one which attains its full development in 
the womb. Nevertheless, cases have been known in which the 
early-born child has grown up hearty and strong, and there are 
also cases in which, for the mother's sake, a premature labor is de- 
sirable, as giving the only possible chance of producing living off- 
spring at all. There may be an unusually small pelvic cavity, 
owing to s&aie malformation, or a narrowing of the passage through 
which the foetus has to pass, so that it can only do so by an opera- 
tion, involving death to the child and great danger to the mother. 
Of course, none but a professional person should be intrusted with 
the delicate task of bringing about a premature birth, and he should 
only do it in a case of absolute necessity. 



LABOR, OR CHILDBIRTH. 315 

LABOR, OR CHILDBIRTH. 

There are certain preliminary matters which deserve attention 
in the preparation of the lying-in chamber. The bed should be 
prepared, or " guarded," by covering the right-hand side of it with 
a skin of leather, or piece of water-proof fabric, laying over these 
three or four folds of sheet. The patient should % change her dress 
so that she have on only her under-garments and night-gown, over 
which, so long as she may be able to move about her room, she 
should wear a loose dressing-gown. The under-garments should be 
so arranged as to be easily slipped down after the labor is ended.' 
The monthly nurse and one female friend should be the only per- 
sons in the room besides the patient and the attendant. The room 
should be well ventilated, and kept at a moderate temperature. If 
the bowels be costive, the patient should take a clyster of warm 
gruel, as soon as labor begins. The last stage of the labor is often 
shortened thereby. The diet, until labor is finished, should be 
light, unstimulating, and nourishing, varying but little from the 
ordinary habit, The conversation should be cheerful, as little as 
possible having reference to labors, and suspended or moderated 
during the pains, as it is often very irritating to. women at these 
moments. 

If she be a strong, healthy woman, and no unusual complications 
arise to disturb the natural process, but little aid or interference 
may be required. There will be the usual warning symptoms — 
intermitting pains in the back, slight at first, but increasing in in- 
tensity ; there will probably be a slight discharge of mucus, stained 
with blood, and perhaps also a considerable discharge of a clear 
fluid, popularly called " the waters ; " this is an albuminous liquid 
filling up the membrane in which the foetus floats, and so prevent- 
ing pressure ; it sometimes does not escape until labor has actually 
commenced, by the falling down of the child into the pelvis. When 
this takes place, the recumbent position should be assumed ; previ- 
ous to this it is best for the patient to sit upright or walk gently 
about, and so assist the action of the uterus. I fe 

• When the child is born, care is to be taken that it haPoreathing- 
room, and that the bedclothes, etc., do not prevent access of air to 
its mouth. When the body has been expelled, it should be turned 
on its back. The infant will generally begin to cry immediately ; 
should this not occur, a few slaps should be inflicted on the face, 
chest, etc., with a towel dipped in cold water. This will in most 
instances suffice to cause the child to draw in a short inspiration ; it 
will then cry, and respiration will be fully established. As soon as 



316 MIDWIFERY. 

this takes place, the navel-string is to be tied and divided. This is 
a very simple operation, and only requires attention to the follow- 
ing directions : Take four or five lengths of strong brown thread ; 
of these make two strings, each about fifteen or sixteen inches long, 
tying a knot at each end. The navel-string being then taken hold 
of, is to be tightly tied round with one of these ligatures, at about 
an inch and a half or two inches from the child's abdomen. The 
other ligature is next to be tied about two inches nearer to the 
mother. The navel-string is then to be cut through with a sharp 
pair of scissors, between these two ligatures. If it should bleed 
afterward, another ligature should be tied. 

Attention must next be given to the placenta, or after-birth. 
The removal of this is often a delicate and dangerous operation. It 
is very commonly discharged without any other assistance than the 
natural power of expulsion given to the womb, within an hour or 
so after the delivery, sometimes immediately after, and until it is 
there must be considerable anxiety as to the result, the labor-pains 
caused by the contraction of the womb continuing at longer or 
shorter intervals to rack the patient, and serious flooding generally 
coming on, if the offending substance is not quickly removed. 
When the after-pains, as they are called, are protracted beyond the 
period above-named, and the placenta does not come away, the 
medical man, or, failing him, an experienced nurse, will generally 
attempt to assist Nature in its removal ; one hand is pressed on the 
lower part of the abdomen, and the other, well oiled, is passed gen- 
tly into the womb, so that it can grasp the after-birth, and, without 
breaking or tearing the substance, bring it carefully away from its 
point of adhesion, waiting for a return of the after-pain to remove 
it entirely. Force must not be used unless the case becomes des- 
perate, and the patient appears likely to sink from a continuance of 
the pains and loss of blood, in which case it is better to risk tearing 
it away ; but in all cases dexterity is better than force. By giving 
the after-birth a slightly twisting motion as it is withdrawn, the 
membranes which line the interior of the womb during pregnancy 
may generally be detached and brought away with it ; but, if they 
cannot, they may safely be left to be afterward discharged, as they 
do not cause the irritation which the placenta does. 

The employment of force in the abstraction of the placenta may 
turn the womb inside out, like a pocket, and thus produce a dread- 
fully diseased condition. In those cases, therefore, in which it does 
not spontaneously come down into the vagina, medical assistance is 
absolutely necessary, if it is possible to get it. 

As soon as the placenta is taken away, a broad bandage or towel 



LABOR, OR CHILDBIRTH. 317 

should be passed round the body of the mother, so as to cover the 
hips, drawn tightly, and pinned or tied, so as to sustain a pressure 
upon the womb, and stimulate the vessels to return to their normal 
condition. 

If the after-pains are severe, they may be relieved by a pill, con- 
taining one grain of opium and two grains of camphor ; but it should 
be remembered that within a certain limit these pains are useful and 
salutary. Perfect stillness is to be enforced for three or four hours. 
It is important that the patient should not be allowed suddenly to 
assume an upright or sitting posture. A little cold tea or gruel 
maybe administered. The soiled garments, etc., are to be removed, 
dry napkins applied, and the patient gently moved up in the bed, 
then left to sleep, if she can. Light nourishment, as beef-tea, gruel, 
sago, tea, etc., may be given from time to time. 

For eight or more days after a labor, the recumbent position 
should be strictly maintained. Some women feel so well and strong in 
a day or two, that they will sit up, and sometimes even get out of 
bed, and make themselves useful in the house. We have seen a 
shoemaker's wife scrubbing the floor the day after delivery, and we 
have heard of females undergoing the pains of labor under a hedge 
by the roadside, and in a few hours proceeding on their journey, 
with their babes at their breasts. But these women were semi or 
entire barbarians; they had not been delicately nurtured. With 
the immense advantages, we must also take some of the disadvan- 
tages of civilization, and those who give birth to children surround- 
ed by all its comforts and luxuries must not attempt to emulate the 
Indian squaw, or the scarcely less favored laboring-women of some 
countries, in this respect ; if they do, they will inevitably suffer 
for their temerity. Getting about too early after childbirth is, per- 
haps, the most fruitful of all sources of uterine disease. The conse- 
quences may or may not show themselves at once, but, whether or 
no, bad consequences there will most likely be ; therefore, we warn 
all mothers to keep their beds long enough. But little exertion 
should be made until the end of the first fortnight ; if there is a ne- 
cessity for getting about earlier, of course it must be done, for neces- 
sity has no law ; but, unless there is, the risk should not be run ; 
delicate women especially do wrong to attempt it, and the strong 
will be likely to render themselves weak by the practice. 

In what has been hitherto said, we have supposed labor to pro- 
ceed naturally; but sometimes events occur fraught with danger, as 
a wrong position of the child, or flooding, or convulsions. 



318 MIDWIFERY, 



PLACENTA PREVIA. 



' If there has been a slight show once or twice some weeks before 
the time, and then the labor begins with flooding, it is probable that 
it is a case of placenta prsevia, in which the after-birth is attached 
to the womb at its mouth, and prevents the passage of the child. 
This accident is rare, but very dangerous. Plug the vagina with 
cloths ; keep the woman on her back and quiet, to prevent pains as 
much as possible, and get a physician, despite any obstacles. 

FLOODING. 

This accident commonly occurs in weakly persons, immediately 
after delivery. It is owing to deficient contraction of the womb. 
If the womb contracts, its muscular fibres, like so many cords, bind 
up the mouths of the blood-vessels, and blood cannot be lost. If, 
on the contrary, from exhaustion or other cause, the womb lies 
loose in the abdomen after labor, the mouths of the vessels are open, 
and the blood is lost in gushes. 

Contraction of the womb is the only remedy for haemorrhage 
from that organ, and therefore our efforts should be directed to se- 
cure this contraction as speedily as possible. One of the most ef- 
fectual means to obtain this is, by friction and pressure of the sur- 
face of the abdomen over the seat of the womb. This part should 
be courageously but cautiously grasped, and well rubbed, until the 
womb is found to contract under the hand, when the bleeding will 
be arrested. Another of the very powerful means of checking flood- 
ing is, dashing cold water on the naked abdomen from on high. 
After thus dashing the cold water on the abdomen, it will be 
proper to continue the application of cold, by means of wet cloths 
kept constantly applied to the parts, till all haemorrhage has ceased ; 
the windows should be at the same time thrown open, and the pa- 
tient covered only with a sheet, and kept perfectly quiet. 

Should this plan fail, or there .is reason to suspect the retention 
of clots of blood in the womb, the accoucheur's hand should be di- 
rectly introduced and the clots be withdrawn, when the bleeding 
will often immediately cease. It is probable that the gentle stimu- 
lus or irritation conveyed to the womb, by the simple introduction 
of the hand into its cavity, has some effect in every instance where 
benefit has followed the practice ; therefore, we may calculate upon 
a frequent advantage from this stimulus alone, even where there are 
no clots to bring away. 

Should the rush of blood be so prodigious as to produce great 



PUERPERAL CONVULSIONS. 319 

and sudden exhaustion, and thus threaten the immediate extinction, of 
life, the warmest and most active cordials must be given. "Wine or 
brandy, in an undiluted state, should be administered ; and, if we 
succeed in rousing the patient, they should be dropped by degrees 
or exchanged for food of a rich and nutritive, but less stimulant de- 
scription. Opium also is, in this condition of the female, of the 
greatest value, especially in irritable, delicate constitutions ; and it 
must be given in the extremity of danger in large quantities, as one 
or two teaspoonfuls of the tincture for a dose (in water, or brandy- 
and-water), to be frequently repeated. Opium restores the lost 
energy of the arterial system, and, in the nervous agitation which 
follows flooding, is sometimes capable of saving persons apparently 
in the jaws of death. 

PUERPERAL CONVULSIONS. 

These are apt to occur during the latter weeks of pregnancy, 
but are more imminent during labor, or the lying-in state. 

In one class of cases the convulsions are preceded by headache, 
giddiness, sense of weight and throbbing, and other symptoms of 
congestion in the brain. In another class, and that the most nu- 
merous, they occur in weak, nervous, and hysterical females. The 
peculiar condition of the constitution in the state of pregnancy, and 
at the time of labor, is the common cause. The fits are sometimes 
excited by indiscretion, by indigestible articles of food. If they oc- 
cur during labor, they generally subside as soon as delivery is com- 
pleted. 

Treatment. — Where there are signs of congestion about the 
brain, leeches should be applied to the head, and strong purgatives 
and clysters administered. Ten grains of calomel should be given 
at once ; if this do not purge in two or three hours, it should be fol- 
lowed by one drop of croton-oil, placed on the tongue or mixed in a 
little sugar. A turpentine-clyster should be administered. Mus- 
tard-plasters should be applied to the soles of the feet or calves ot 
the legs. Stimulants should at the same time be given. 

In the other class of cases, such as occur in hysterical, nervous, 
and feeble women, with small pulse, a different plan of treatment 
must be followed. Here the fits are rather dependent upon exhaus- 
tion than on congestion. Let the patient breathe from time to time 
a little chloroform on a handkerchief — not enough to put her to 
sleep, but sufficient to quiet the system and prevent the wear of 
labor. 



320 MIDWIFERY. 



MANAGEMENT OF THE INFANT. 



Where we gave directions for cutting the navel-string, we told 
what should be done previously to secure some vital signs from the 
child. The cord should not be cut till the child has given indica- 
tions of life, as, until it has breathed, it must depend upon the cir- 
culation from the placenta. 

Should the child not breathe after the above-mentioned measures 
have been adopted, it should be placed in a warm bath, while at- 
tempts are made to innate its lungs by breathing into its mouth, 
holding the nostrils, to prevent the escape of the breath that way. 
Gentle pressure should at the same time be made upon the upper 
part of the windpipe (Adam's apple), to open the orifice of the larynx, 
and thus facilitate the entrance of air into the lungs. The sides of 
the chest should then be gently depressed, so as to empty the lungs. 
These operations may be alternately repeated so long as the slightest 
pulsation can be felt in the region of the heart. 

The child, having been separated from its mother, is to be 
wrapped in a warm flannel. It should then be well washed with 
warm water and soap, near (not close to) a fire. The child's body 
is covered with a white, unctuous substance, which is sometimes 
difficult to remove. If the first soap-and-water washing do not re- 
move this, the surface should be smeared with oil or lard before the 
second washing ; this will soften the white substance, and render it 
more easily removable by soap and water. 

When the child has been wiped dry, the remainder of the cord, 
or navel-string, is to be enclosed in two or three folds of soft rag, 
and laid upward on the abdomen. A band of soft flannel should 
then be passed twice round the body, not tightly. If the navel- 
string should ooze at all — and this should be carefully noticed before 
the bandage is placed — a second ligature should be tightly tied. 
If, however, it should still bleed, a little plaster of Paris, if it can be 
procured, will stop, or treat as in bleeding from leech-bites. In 
from five to ten days the navel-string separates ; it should not be 
pulled at, as this may lead to protrusion afterward. Swelling or 
pufliness of the scalp is generally noticed after hard labors. This 
may be left to itself, and will disappear in a few days. After the 
washing and dressing are complete, the child should be placed in bed 
with its mother, and its mouth put to the nipple. There may or 
may not be milk at first, but the child's suction accelerates the se- 
cretion, and stimulates the womb to contract, thereby diminishing 
the risk of haemorrhage. 

The warmth of the mother will be of service to the infant. 



PUERPERAL FEVER. 321 

!N"ewly-born children do not maintain their own warmth. "When 
thoroughly warm, the infant may be placed upon a pillow in a cot 
or bassinette. If no milk appear in the mother's breast after twelve 
hours, nothing should be given to the infant but warm milk-and-wa- 
ter ; this should be repeated every two hours until the mother can 
afford a supply. 

Castor-oil, butter-and-sugar, etc., are often forced down the 
throats of infants, for no good reason whatever. The first milk that 
is secreted by the mother has all the aperient properties that can 
be ordinarily needed for the removal of the dark secretion contained 
in the bowels of the child at birth. There is certainly no occasion 
to physic a child directly it comes among us. If the contents of 
the bowels should not be evacuated for a couple of days, a teaspoon- 
ful of castor-oil may be given. Accurate examination should first 
be made, in order to ascertain that no malformation exists to pre- 
vent the passage of the motion. 



PUERPERAL FEVER. 

This is a fever of a very high character, arising from inflamma- 
tion of the serous membrane, and sometimes of the womb itself, and 
of its veins and absorbents ; it runs a very rapid course, and is often 
fatal. It assumes the character of an epidemic, and frequently causes 
great mortality ; whether it is really contagious or not is yet an open 
question. The circumstance that it has been known in several in- 
stances to attack the patients of one medical man, while all others 
in the locality have remained free, seems to favor the impression 
that it is. The mere probability that it may be so should render 
persons extremely cautious in their intercourse with those who are 
suffering under it. This is sometimes called puerperal peritonitis, 
because the peritonaeum appears to be its chief seat ; great tender- 
ness of the abdomen,. with fulness and tension, is one of its most 
constant and characteristic symptoms ; there are also usually an 
anxious countenance, sickness, hurried respiration, a furred tongue, 
and a stoppage of the secretions, especially of the milk. When 
these symptoms occur soon after childbirth, no attempt should be 
made at domestic treatment ; let the medical man be summoned 
immediately, if he be not in attendance. If the patient is able to 
bear it, he may bleed and leech pretty freely, and give a full dose of 
calomel, followed by castor-oil, and employ other depletive measures, 
to reduce the inflammatory action ; this active treatment will be fol- 
lowed up with calomel and opium in grain-doses, should the pain and 
inflammatory symptoms continue. It is often difficult to distinguish 



322 MIDWIFERY. 

between this fever and true peritonitis, and only one skilled in the 
diagnosis of disease would be likely to treat it properly. . 



INSANITY, PUERPERAL. 

Either a few days or hours, it may be before, or more commonly 
after childbirth, the mother becomes somewhat strange and excited, 
suspicious of her friends and attendants, imagining evils and dan- 
gers to herself or child ; or her affections are entirely alienated from 
her offspring, which, if not carefully watched, she might injure. The 
patient's spirits are greatly depressed ; she will cry often and long ; 
melancholy alternating with the state of excitement characterized 
by incoherent volubility and irritability of temper. The pulse may 
be increased in rapidity ; but this, as well as other bodily symptoms, 
may show but little indication of disease. 

The symptoms may subside in the course of a few days or hours, 
or they may pass into furious mania or melancholy. The above 
constitutes the faintest outline of this affection, which presents many 
forms and degrees of severity. It should suffice, however, to put 
the attendants of a lying-in woman upon their guard, in the event 
of the appearance of such symptoms. 

Upon the first occurrence of the symptoms in a milder degree, a 
dose of tincture of opium, twenty to fifty drops, should be given, 
and repeated at intervals of four or six hours, according to the effect 
produced. An aperient draught should be given if the bowels are 
costive. The greatest care and vigilance are required, in watching 
that the patient does not injure herself or offspring. When such 
symptoms appear, the woman ought never to be left entirely alone. 
If she be very violent, the arms may be pinioned down to the sides 
by a strait-waistcoat, or a sheet folded broad and firmly bound 
round the body. This should not be had recourse to if it can safely 
be avoided ; but, where there are not sufficient or competent attend- 
ants, it is the best plan to use some restraint of this kind. By 
thereby preventing the patient from augmenting her excitement, 
she will often become quiet, and fall off into a refreshing doze. 

It is scarcely necessary to observe how important it is, in such a 
case, to spare no effort to obtain medical advice. 



MILK FEVER. 

At the secretion of milk there is some inevitable excitement, and 
what is called milk fever is an aggravated form of the excitement, 
which takes place at the onset of lactation : its first symptoms are 



GATHERED BREAST. S23 

increased heat of the system, preceded by shivering, and sometimes 
accompanied with vertigo and slight delirium ; these are followed 
by severe headache, thirst, dry tongue, quick pulse, throbbing of 
the temples, and intolerance of light. 

The cause may be a cold, or overheating the apartment, too 
stimulating a diet, or any obstruction to the flow of milk from the 
breast. 

The treatment should be spare diet, perfect tranquillity, subdued 
light, cooling drinks, and saline aperient medicines ; the head should 
be kept somewhat elevated, and bathed with cold water or evapo- 
rating lotions. If the symptoms should become worse in spite of 
this, apply half a dozen or more leeches to the head, and put the 
feet in a warm mustard-bath. Most lying-in women have more or 
less of this fever ; if, however, it is not checked, the arterial action 
runs too high, and no milk at all is secreted. 



GATHERED BREAST {Milk Abscess). 

There are sharp, shooting pains, and hardness of the breast, with 
redness of the skin, as the inflammation extends and approaches the 
surface ; feverishness ; when matter has formed and comes to the 
surface the pain is less acute, but still severe and throbbing ; shiver- 
ing takes place ; the skin becomes discolored at one or more points, 
then gives way, and the matter is discharged often in great quan- 
tities. 

Such are the symptoms in the commonest form of inflamed 
breast, occurring to women who are suckling or weaning. Inflam- 
mation of the breast does, however, sometimes occur in young girls, 
especially about the period of puberty. The pain is considerable, 
but it seldom proceeds to the formation of abscess. Even the 
breasts of newly-born infants are apt to become inflamed ; but this 
inflammation rapidly subsides, if let alone. 

The causes are cold ; bruises ; weaning ; irregularity or want of 
care in nursing, by which the breasts are permitted to become 
loaded and over-distended with milk. 

Treatment. — In the outset, rags wetted with tepid water may 
be laid on the breast, which should be supported by a handkerchief 
passed under it. The fulness of the breast is relieved by suckling, 
or the breast-pump or drawing-glass. In addition to this, the rub- 
bing the surface of the breast gently with camphor-liniment three 
or four times a day will often disperse the hardness. 

If the preceding means fail, let the breast be well but gently 
rubbed with a soft hand, into the palm of which is poured fresh 



324 MIDWIFERY. 

olive or almond oil ; the friction should be continued for about ten 
minutes, and repeated every four hours or so. Goose-grease and 
other fatty substances are recommended, but simple oil is best, the 
friction being the principal agent for good. Between the intervals 
of this, the breast should be kept covered with a tepid-water dress- 
ing, having over it oiled silk to prevent evaporation. Care should 
be taken during this treatment to keep the bowels gently open, and 
to keep under the febrile symptoms. Leeching the breast in case 
of threatened abscess is sometimes resorted to, but its utility is very 
questionable ; at all events, it should never be done unless under 
proper direction. There may be cases in which it is advisable. A 
mammary abscess will frequently continue discharging for a con- 
siderable period, and, during this time, the patient should be sup- 
ported by a nourishing, although light diet : stimulants are gener- 
ally to be avoided, but sometimes they are really necessary. A 
warm bread-poultice is best for the abscess ; it should be changed 
about every four hours, and covered with oiled silk : when the dis- 
charge has nearly ceased, simple tepid-water dressings may be sub- 
stituted. The breast, during all this time, should be supported by 
a soft handkerchief, tied round the neck. An application of collo- 
dion all over the part has sometimes been used; it forms a thin 
coat, which, contracting as it dries, affords the necessary support, 
if the breast is not very large and heavy. If some amount of press- 
ure is required, strips of strapping crossing each other will effect 
this object. 

CRACKED NIPPLES. 

Yery painful and distressing cases of sore nipples frequently 
occur after childbirth. Sometimes they cannot be avoided, but fre- 
quently they arise from too great an anxiety on the part of the 
mother, who is constantly meddling with them, applying the mouth 
of the child, and resorting to all sorts of expedients to draw them 
out. A judicious nurse will prevent this, and also take care to 
guard the breasts, as much as possible, from those constant alterna- 
tions of wet and dry to which they are exposed. Nipple-shields of 
ivory, or glass, with india-rubber teats, may be readily procured, 
and should be used when the nipples are too sore and tender to 
bear the application of the child's mouth : in this case, the milk 
must be drawn from the breast by one of the contrivances above- 
mentioned, and given to the child in a feeding-bottle. Glycerine 
has been found a good application for chapped or otherwise sore, 
nipples ; it must be applied with a camel's-hair brush, first wiping 



WHITE LEG. 325 

the part dry with a piece of soft linen : if obtained pure, there will 
be little or no smell in it to annoy either mother or child. 



WHITE LEG {Inflammation of the Veins of the Lower Extremity). 

At an uncertain interval after childbirth, the patient experiences 
shivering, sickness, rapid pulse, sense of prostration, thirst, and 
furred tongue. Pain is felt in the region of the womb, and, in the course 
of a day or two, extends to the groin and upper part of the thigh, 
which are tender when pressed. The tenderness may be traced in 
a narrow line along the inner side of the thigh down to the back of 
the knee-joint, and down the calf of the leg. The skin of the leg 
and entire limb becomes tense, white, and shining ; hence the name 
of the malady. The impression of the finger is retained for some 
seconds after its pressure has been removed. Movement of the limb 
becomes painful. These symptoms vary greatly as to degrees of 
severity and as to duration. In some instances they may all have 
disappeared in a few weeks ; in others they may last for months, 
and prove a source of much pain and difficulty in walking. 

One or two dozen leeches should be applied to the groin, fol- 
lowed by fomentation and poultices. Ten grains of Dover's powder 
to be given at bedtime, to allay pain. The bowels should be regu- 
lated by four or five grains of blue-pill and a dose of castor-oil, or a 
rhubarb-draught. The diet should be light and unstimulating. As 
the inflammation extends down the limb, the occasional application 
of a few leeches at different points will be found serviceable. 

The entire limb should be enveloped in flannel wrung out of 
warm water, and then enclosed in thin water-proof material. The 
best kind is the thin gutta-percha tissue. This application to be 
changed as often as required to keep the limb warm. When all the 
inflammatory symptoms have subsided, the stiffness and immobility 
of the limb may be relieved by the use of stimulating liniments. 



CHILDREN AND THEIR DISEASES. 



FEEDING. 



One of the most fruitful sources of disease, in the early days of 
infantile life, is improper management in relation to diet, and a 
large proportion of the suffering and mortality which occur during 
this period arises from this cause alone. It is necessary to nurse 
upon a regular plan, to insure the present and future health of the 
child. 

It is a great error to give the infant either the breast or the bot- 
tle too frequently ; every three or four hours will be often enough 
in most cases ; a child is not always hungry when it cries ; there 
may be pain or uneasiness of some sort, and overfeeding will only 
increase the evil, although sucking may for a time keep it quiet ; 
the digestive organs require rest with the young, as with adults. 

The position of the infant during the time of feeding is of conse- 
quence ; if fed from the breast, it will naturally be placed in a semi- 
erect position ; and if artificially, rt should also be slightly raised, 
and in the latter case care should be taken to keep the body warm ; 
for it should be remembered that, while suckled at the breast, it 
derives great warmth therefrom ; in this position, too, it can swal- 
low the food more comfortably than when laid flat on its back, and 
the nurse can more easily perceive when it has had enough. 

During the first few weeks of existence, the infant will fall asleep 
immediately after having the breast, and this, as being the order of 
Nature, ought to be encouraged. If, from thoughtless gayety or ac- 
tivity in the nurse, it be dandled, carried to the window, or other- 
wise excited, indigestion will be sure to follow, accompanied possi- 
bly by nervous irritation, colicky pains, or bowel-complaints ; even 
when so much sleep is no longer required, quiet for some time after 
feeding ought to be encouraged, as much bodily activity immedi- 
ately after meals is unfavorable to easy digestion in a delicate con* 
stitution. 



WEANING. 327 

If the child require to be fed artificially, it should be on milk. 
Milk ought to be the diet of infants for a certain time, and it alone 
will be sufficiently nourishing for nineteen out of twenty children. 
Fewer children would perish, if so fed, than are destroyed by rush- 
ing into the opposite extreme of feeding them with more viscid 
food; the use of farinaceous food for all infants under the age of 
nine months taxes severely the powers of assimilation. 

The best substitute for the breast-milk is a mixture of two parts 
cow's milk, one part water, and this well sweetened with loaf sugar. 
There is but little fear of making it too sweet, as any one will un- 
derstand who tastes a sample of good, healthy breast-milk. In vig- 
orous children, there may be added to this mixture a small portion 
of the strained fluid from well-boiled oat-meal or barley. As to the 
temperature of the food, our great aim ought to be to follow as 
much as possible in the footsteps of Nature ; and as we may observe 
that 96° or 98° Fahr. is the temperature of the mother's milk, so 
should we give it to the infant ; and, for the purpose of regulating 
this, as well as the state of the atmosphere, a thermometer should 
be kept in every nursery. The milk should not be boiled, but a jug 
containing it may be placed in boiling water, and so the required 
heat obtained. 

The only proper apparatus for feeding a child is the simple plain 
glass nursing-bottle, with a wide mouth and a plain India-rubber 
tube or nipple. Reject absolutely all the patent contrivances by 
which the food is drawn up through tubes. The great necessity is 
that the bottle should be kept scrupulously clean, and this is only 
possible in the plain bottle and nipple. In all the other contriv- 
ances, some of the food remains and gets sour. Neither the bottle 
nor the nipple should ever be laid aside without being thoroughly 
washed with hot water, and wiped dry. The mouthpiece should not 
be put into the bottle until required. A bottle-brush, an extra teat, 
and an extra bottle, in case of accident, should be kept in the nursery. 



WEANING 

If a child has cut four teeth, is in good health, and its bowels 
are regular, it should be weaned when nine months old, and without 
any previous preparation. It should be fed with a spoon, on food 
of biscuit-powders, or some other farinaceous preparation, made 
with cow's milk. A delicate child may be kept a1? the breast until 
it is a year old, but not much beyond that. If a lately- weaned child 
is attacked with whooping-cough, or any other severe disease, it may 
be necessary to give it the breast again ; or should a weaned child 
22 



328 CHILDREN AND THEIR DISEASES. 

refuse artificial food, and pine away under the deprivation, a breast 
of milk should be provided for it. 

Exercise and Air. — In warm and very fair weather, an infant 
might be taken out-of-doors when a month old ; in winter it should not 
be taken out at all. A child born in the fall must be kept in till May, 
and then only taken out if the day is fine, and for not more than 
twenty minutes ; if an east wind prevails, the child should be kept 
in-doors. Sleep should never be encouraged in the open air, nor 
should the glare of the sun be allowed to fall on its face ; of course, 
the morning chill and evening damp should be avoided. When the 
infant does go out, let it be in the nurse's arms, not in a perambu- 
lator ; it needs the heat of the nurse's body. 

An infant should be washed regularly every morning in warm 
water, and it will further conduce to health to put it for a few min- 
utes in a tepid bath, every evening at bedtime. After washing, re- 
action should be promoted by gentle friction of the hand for a few 
minutes, allowing the child to stretch its limbs before the fire, 
although at a proper distance from it. The most scrupulous care 
should be paid to the state of the skin, as the matter which is conveyed 
away by this excretory organ would be likely, if retained, to act most 
injuriously upon the susceptible nervous system of an infant. An- 
other matter to be carefully attended to, in fat children especially, 
is the condition of the opposing surfaces of the skin in the creases 
and folds; troublesome sores, and much local irritation, acting preju- 
dicially upon the whole system, are often the result of the chafing 
which here takes place if this be neglected ; the moisture of such 
parts should be absorbed by the starch-powder, and a piece of soft 
linen, spread with spermaceti-ointment, and dipped in elder-flower 
water, should be inserted between the folds of the skin. 

Sometimes a child's navel does not properly close, and then there 
is protrusion of the bowels as often as the child cries, or is in any 
way violently excited ; in this case there should be placed, under 
the binder, a tolerably-stout compress of linen, so as to press lightly 
upon the aperture ; this will be sufficient for the first six weeks or 
so, but after that a more effectual remedy must be applied, in the 
shape of a slice of cork, about the eighth of an inch thick, and suffi- 
ciently large to cover and project some distance beyond the aper- 
ture, padded to an inch thick with folds of linen, and affixed to two 
pieces of plaster. 

The plaster must be warmed, and stuck on the belly of the child, 
in the form of a cross, and the binder placed over, so that the cork 
covers and presses upon the opening of the navel. This apparatus 
should be renewed every two or three days ; when there is inflam- 



DISEASES. . 329 

matory tendency, the cork will probably have to be removed, and 
linen pads only used for a time ; or an air-pad of vulcanized India- 
rubber may be substituted. 

DISEASES. 

The diseases of infants are: 1. Disorders of the stomach; 2. 
Disorders of the bowels ; 3. Exhaustion ; 4. Febrile affections ; £. 
Exanthematous diseases, or those which are attended with eruptions 
of the skin ; 6. Affections of the head ; 7. Diseases of the thorax, or 
chest ; 8. Affections of the abdomen, or belly. 

Disorders of the stomach generally depend on improper diet, or 
they may be secondary, and the effects of a disordered or confined 
state of the bowels. They are often detected by acid or fetid eruc- 
tations and breath, or by the unusually frequent regurgitation or 
vomiting of food. 

Disorders of the bowels can never be mistaken or overlooked by 
an attentive nurse, the evacuations, in their number and appear- 
ance, being the perfect index to these disorders. 

It must never be forgotten that, whenever the system has been 
exposed to sources of exhaustion, this condition may become, in its 
turn, the source of various morbid affections, which are apt to be 
ascribed to other causes, and treated by improper, and therefore 
dangerous, measures. If the infant has had diarrhoea, or if it has 
been bled by leeches ; or if, without these, its cheeks are pale and 
cool; and if, under these circumstances, it be taken with symptoms 
of affection of the head, do not fail to remember that this affection 
may be the result of exhaustion. This important subject is gen- 
erally misunderstood. 

Fever is sooner detected. In every such case it is advisable not 
to tamper nor delay, but to send for the medical man, and watch 
the little patient with redoubled care and attention, 

Especially examine the skin, hour after hour, for eruptions. It 
may be measles or scarlatina, etc. It will be especially desirable to 
detect these eruptions early, and to point them out to the physician. 
Above all things, let not a contracted brow, an unusual state of 
the temper or manner, unusual drowsiness or wakefulness, or start- 
ing, and especially unusual vomiting, escape. 

Be alive to any acceleration, or labor, or shortness of the breath- 
ing, or cough, or sneezing, or appearance of inflammation about the 
eyes or nostrils. These symptoms may portend inflammation within 
the chest, whooping-cough, or measles. Pain of the body, with or 
without vomiting, or diarrhoea, with or without a morbid state of 
the bowels, or of the discharges, ought also to excite immediate at- 



330 CHILDREN AND THEIR DISEASES. 

tention. One caution should be given on this subject : some of the 
most alarming and fatal affections of the bowels, like some affections 
of the head, are unattended by acute pain or tenderness ; their acces- 
sion, on the contrary, is insidious, and it will require great attention 
to detect them early. 

Another view, and another mode of the classification of the dis- 
eases of infants, full of interest, and of admonition, is — 1. As they are 
sudden; or 2. As they are insidious; or 3. As they are,'in the 
modes of accession, intermediate between these two extremes. 

Of the sudden affections, are fits of every kind, croup, and some 
kinds of pain, as that of colic ; of the second class are hydrocephalus, 
or water on the brain, and tubercles in the lungs or abdomen, consti- 
tuting the two kinds of consumption. Fits, again, are cerebral, and 
arise from diseases within the head, or from irritation in the stomach 
and bowels, or from exhaustion ; or they are evidence of, and de- 
pend on, some malformation or disease of the heart. 

Domestic treatment should never be trusted in such serious affec- 
tions as these ; not a moment should be lost in sending for the medi- 
cal man. 

If any thing may be done in the mean time, it is — 1. In either of 
the two former cases to lance the gums ; 2. To evacuate the bowels 
by the warm- water injection, made more active by the addition of 
brown sugar ; 3. And then to administer the warm bath. An im- 
portant point, never to be forgotten in the hurry of these cases, is to 
reserve the evacuations for inspection, otherwise the physician will 
be deprived of a very important source of judgment. 

In cases of fits arising plainly from exhaustion, there need be no 
hesitation in giving five drops of sal-volatile in water ; light nour- 
ishment may be added ; the feet must be fomented, and the recum- 
bent posture preserved. 

In fits arising from an affection of the heart, the symptom is ur- 
gent difliculty of breathing ; the child seems as if it would lose its 
breath and expire. In such a case, to do nothing is the best course ; 
all self-possession must be summoned, and the infant kept perfectly 
quiet. Every change of posture, every effort, is attended with danger. 

In many cases of convulsions, and other infantile affections, the 
use of the gum-lance affords the simplest, quickest, and readiest 
means of affording relief. ' In any case of this kind, should there 
appear to be danger from delay, let the mother carefully pass her 
finger along the child's gum, and, if it appears to be unnaturally 
tumid at any particular part, let her apply the instrument there. 
If the affection be a fit, it may be used, whether any part of the gum 
is hard and swollen or not, simply as the easiest mode of relieving 



DISEASES. 331 

the system by bloodletting. A gum-lancet should always be kept, 
but, should this not be at hand, a common lancet or a sharp penknife 
will do. Make a free incision along the course of the gums, down 
to the teeth, or socket, if there be none ; have the child's head held 
perfectly still, and be careful to guard against pushing the instru- 
ment too far back, so as to wound the throat. The operator should 
remember that perhaps the child's life depends upon the due per- 
formance of this duty, and nerve herself for the task. 

There are many diseases to which infants are liable, which are 
very insidious in their advance, and present at first no very marked 
symptoms ; but the watchful eye of the mother, or of a careful 
nurse, can generally detect the approach and progress of such — 
the countenance, manner, gestures, and motions of the child ; the 
peculiarities of its cry ; the state of its secretions and excretions — 
all afford indications of this, and any thing new or strange in 
either of these is sufficient to give the alarm and excite inquiry. 
If there is a falling off in the looks, color, and flesh of the child, 
there is reason to apprehend the formation of tubercles in the lungs 
— the harbingers of consumption. 

The medicines and remedial means which must be kept for nurs- 
lings are few and simple : rhubarb, magnesia, and manna for aperi- 
ents, with castor-oil ; a few senna-leaves also, for infusion, may be 
useful. Ipecacuanha, powder and wine, as an emetic ; and for cor- 
dials, brandy and sal-volatile, the former for exhaustion generally ; 
the latter when this is connected with pain and irritation of the 
bowels. What shall we say about anodynes, but simply to warn 
against their use ? except under the direction of the medical man ; 
nevertheless, it may be prudent to have at hand a small bottle of 
paregoric, of which, in violent and excruciating pain, a few drops 
may be given. If a carminative, essence of aniseseed is the best, to 
be combined, where there is much flatulency, with fetid spirit of 
ammonia, this with a little carbonate of soda for acidity of stom- 
a h; aromatic confection for loose bowels; and poppies and cham- 
omiles for fomentations, may complete the stock of medicines, which 
should be kept under lock and key, and only administered by the 
mother, or a nurse who can safely be trusted. But the warm bath, 
the injection, and the tooth-lancing, are the safest remedies ; there- 
fore, let the . apparatus necessary for these be always at hand and 
ready for use. 

DENTITION. 

When the child is born, the jaw is covered with gums, but 
underneath the gums are little cavities in which the teeth are 



332 CHILDREN AND THEIR DISEASES. 

formed ; and, as they go on growing, they at last press upon the 
gum, and, causing it to absorb, finally break through it. This pro- 
cess is frequently a source of disordered, health to children, espe- 
cially if any thing occurs to prevent the absorption and ready 
yielding of the gum to the pressure of the tooth below. The ab- 
sence of teeth during the period of human infancy evidently indi- 
cates that the food required at that period does not need their 
employment, but it is too often forgotten that, till teeth are devel- 
oped, Nature does not intend the child to take food that requires 
preparation by teeth in order to its digestion. The practice of feed- 
ing young children with solid food is the cause of great destruc- 
tion of life ; and even sops should only be sparingly administered, 
in cases of necessity, till the first teeth have appeared. 

The order in which the teeth appear — as well as the time — is 
subject to considerable deviations, but the following periods will 
be found to be as near right as any rule liable to common exception 
can be : 

First, or Milk Teeth. 

2 lower middle incisors, . . . 4th to 8th month. 
2 upper " " ... 4th to 8th " 

4 lateral incisors, . . . . *7th to 11th " 

4 anterior, or 1st molars, . . . 12th to 18th " 

4 eye, or canine teeth, . . . 16th to 22d " 

4 back molars, . . . . 19th to 38th " 

20 

In some children, the whole of the teeth may be cut by the end 
of the third year, while in others the process of dentition may be 
prolonged to the fifth year. 

Order of Appearance of the Permanent Teeth. 

4 first molars, one on each of the two 

sides of the two jaws, . . . 6th to 7th year. 
4 middle incisors, two in each jaw, . 7th to 8th " 
4 lateral incisors, a little later than 

the last, . . . . 1th. to 8th " 

4 first bicuspids, . . . . 8th to 9th " 

4 last bicuspids, . . . . . 10th to 12th " 

4 eye, or canine teeth, . . . 11th to 13th " 

4 second molars, 12th to 14th " 

4 back molars, or wisdom teeth, . 18th to 30th " 

32 



mumps. 333 

Dentition is commonly preceded and accompanied with various 
symptoms : the child drivels ; the gums swell, spread, and become 
hot ; there is often a circumscribed redness in the cheek, and erup- 
tions on the skin, especially on the face and scalp ; looseness ; grip- 
ings; stools, green or pale, or otherwise discolored; watchings, 
startings in the sleep, and spasms of particular parts ; a diminution 
or increased secretion of the urine, which is often of an unnatural 
color ; now and then a discharge of matter, with pain in making 
water ; in almost all cases the child shrieks often, and thrusts its fin- 
gers into its mouth. Less common symptoms are a swelling of the 
tops of the feet and hands; the tumefying of one or more of the 
glands of the neck ; and cough, difficult breathing, and fits. 

In the treatment of difficult teething, preserve a free state of the 
bowels. It is surprising how great and perfect a change will often be 
wrought in the case of fever, convulsions, and other alarming symp- 
toms arising from teething, by procuring an evacuation and improv- 
ing the secretions by the use of minute doses of calomel and jalap. 
Whenever, therefore, the teething of a child is difficult or painful, 
give immediately a little rhubarb and magnesia, or four grains of 
compound jalap-powder, in water, and afterward a teaspoonful of 
castor-oil daily, so that the bowels may be freely moved every day ; 
to which add great attention to diet, which should be very simple, 
smaller in quantity than usual, and of the most digestible nature, 
with plenty of pure air and exercise. 

A very excellent medicine for children during teething is the 
liquor potass ce, or alkaline solution, with rhubarb, as prescribed in 
this form : 

Take of liquor of potassa, or alkaline solution, . . 1 drachm. 

Infusion of rhubarb, 6 drachms. 

Dill-water, *7 drachms. 

Simple syrup, 2 drachms. 

Give the child one teaspoonful twice or thrice a day. 

MUMPS. 

This disease, which is a contagious epidemic, consists of inflam- 
mation of the salivary or parotid glands, which are situated on each 
side of the lower jaw. It commences with slight febrile symptoms 
of a general character ; very soon there are redness and swelling at 
the angle of the jaw, which gradually extend to the face and neck 
near to the glands ; these sometimes become so large as to hang down 
a considerable distance, like two bags. But little medical treatment 
is required for this disease when at its height : the patient, from 
sheer inability to move the jaw, must live chiefly on liquid food ; and it 



334: CHILDREN AND THEIR DISEASES. 

is well for him to be kept low, unless very delicate, in which case a 
little good broth or beef-tea should be given. If there is much pain, 
the throat should have hot fomentations applied, and perhaps two or 
three leeches. Mumps is not a dangerous disorder, unless a too active 
local treatment is resorted to. This, however, while it will seem to 
subdue the disease, will merely drive it elsewhere. It will then 
affect in boys the testicle, and in girls the breast, or the brain in 
either, and the disease becomes more dangerous as the system is 
more disturbed by disease of these parts. 

THRUSH. 

This disease is common with infants who are fed improperly, or 
upon artificial food ; it consists of an eruption of small white or ash- 
colored ulcers, on the inside of the mouth and edges of the lips, not 
unfrequently extending to the throat and fauces ; it is caused by irri- 
tation of the bowels, and generally gives rise to excoriations about 
the anus and nates. When these symptoms appear, nurses say it is 
" going through " the child, and indicate a speedy termination of the 
disease. Under ordinary circumstances, and if sufficient attention 
be paid to it, thrush is not a dangerous affection ; but, if neglected, 
and sometimes if not, it assumes a gangrenous character, the ulcers 
increase in size and become livid ; it is then much to be feared. 

Treatment. — As this disease is nearly always attended with diar- 
rhoea, some anti-acid and astringent mixture should be given, after, 
perhaps, one dose of rhubarb and magnesia ; the compound chalk- 
mixture of the pharmacopoeia, with a few drops of laudanum, should 
the irritation be very great. To the eruptions of the mouth should 
be applied, with a camePs-hair brush, a little honey and borax, in the 
proportion of six drachms of the former to two of the latter ; or, in 
aggravated cases, a lotion composed of nitrate of silver, one scruple 
dissolved in one ounce of water. Dust over the excoriated nates 
and anus with hair-powder, or damp them with Goulard-water, two 
or three times a day. If the child is at the breast, great attention 
should be paid to the diet of the nurse ; if not, the food must be at 
once simple and nutritious, milk forming the chief part of it. If the 
disease assumes a gangrenous character, there will be great exhaus- 
tion, and beef-tea and tonics will be required ; for young children 
something like this : 

Dilute nitric acid, lj minims ; 

Syrup of orange-peel, £ an ounce ; 

Infusion of calumba, 1 drachm ; 

Water, 3 ounces. 

Take a dessert-spoonful twice or three times a day. 



RED GUM.— MILK CRUST. 335 

RED GUM. 

This generally attacks infants at the breast, and is characterized 
by an eruption of minute hard pimples, sometimes of a pale color, 
but more commonly red ; except that their itching causes the child 
considerable annoyance at times, they are by no means very trouble- 
some or dangerous ; of themselves, they are of little consequence, 
but, as symptomatic of some internal disturbance, they demand at- 
tention. When they appear, the action of the bowels should be 
carefully watched, and aperients administered if necessary. For 
the. eruption, tepid baths, about twice a week, should be resorted to. 



MILK CRUST. 

The treatment of this is the same with the treatment of nearly 
all the skin-diseases that occur in childhood, especially during the 
period of dentition, and seem to be intimately connected with the 
disordered state of the bowels, which generally prevails at that 
period of increased irritability of the system. The general treat- 
ment consists in correcting the irritable state of the stomach, and 
clearing the alimentary canal of crude, undigested matter ; a pow- 
der like the following will best effect this with children : 

Gray powder, 12 grains. 

Antimonial powder, 6 grains. 

Sesquicarbonate of soda, rhubarb, and cinnamon-powder, each, \ a drachm. 
Divide into six powders and take one every other night ; if for a very young 
child, half the strength will do. 

The local treatment will be the application of ointment of zinc, 
acetate of lead or tar with sulphur; should it prove obstinate, apply, 
morning and night, ointment of nitrate of silver, diluted with three 
times its weight of lard. The following wash is effective : 

Solution of the subacetate of lead, .... 1^- drachms. 

Hydrocyanic acid, . . . . . . . .2 drachms. 

Distilled water, . . 6 ounces. 

Much depends upon diet (nothing crude or indigestible should 
be taken to irritate the system), and much also on cleanliness ; soap 
and warm water should be frequently used, and the patient should 
take regular and gentle exercise ; if weak, he should have nutritious, 
although not rich food. These are generally tedious cases, and there- 
fore immediate success must not be looked for. 



336 CHILDREN AND THEIR DISEASES. 

CHOLERA INFANTUM. 

This is a disease almost peculiar to the climate of the United 
States, and limited very much to the middle and Southern States. 
Children, in other countries, are liable during dentition, or from 
other causes, to various affections of the alimentary canal, all of 
which differ from this. The exciting causes are, improprieties in 
diet and clothing ; and it is, likewise, very often aggravated by 
teething, worms, by premature weaning, and by a variety of ad- 
ventitious circumstances. 

Cholera infantum makes its approach in different ways. In some 
instances it comes on as a simple diarrhoea, though the stomach is 
also very apt to be affected; and in its more violent forms there are 
vomitings and purgings, attended by no considerable spasmodic un- 
easiness. In its ordinary forms, the fever, which soon supervenes, 
is of an irregular, remittent character, highest in the evening. The 
pulse is usually small, quick, and feeble, or irritated and corded, but 
rarely full, strong, or voluminous. Determinations to the brain are 
common, or, at least, this organ seems early to be affected^ sympa- 
thetically, as is manifested by a tendency to stupor or delirium, or, 
sometimes even frenzy. The eyes denote this cerebral affection: 
they are either fierce or languid in expression, and, when the patient 
sleeps, are half closed. Thirst is intense, and for a time really un- 
quenchable—cold water is clamorously demanded, but, if swallowed, 
is immediately rejected. An unequal distribution of temperature 
commonly exists ; the head and region of the stomach and bowels 
being hot, while the extremities are cold. 

The appearances of the evacuations from the bowels are various. 
The natural fseces are mostly retained, though occasionally small 
lumps may be found involved in the other discharges. These are 
sometimes thin and watery, and at other times thicker and more 
tenacious, consisting chiefly of slime, or mucus occasionally tinged 
with blood. The color may be green, or yellow, or white, or brown, 
and they may be inodorous or exceedingly offensive. Commonly, 
however, the smell is that of sourness or of putridity. The irrita- 
bility of the alimentary canal is sometimes so great, that the ingesta 
pass off unaltered. 

The child, at first, becomes pallid, and the flesh flabby, and so 
completely is the fat ultimately absorbed, that the integuments 
hang in folds, and, in those parts on which the body rests, livid spots 
appear, followed by ulcerations. The skin on the forehead is tight, 
as if bound to the bone, the eyes are sunk, the cheeks fall in, the 
nose is sharp, and the lips are shrivelled. The belly becomes tumid 



CHOLERA INFANTUM. 337 

from flatulence, the feet still more frequently are cedeniatous, aphthae 
appear; the mind and the senses, which hitherto may not have been 
impaired, are now obtuse, or so entirely lost that the child lies un- 
moved by ordinary excitements, and will even allow flies to collect 
on the face without being irritated or disturbed. This form of the 
disease will sometimes continue for five or six weeks. But, as death 
approaches, a gradual aggravation of symptoms takes place, and 
there is one which seems always to indicate a fatal result. It is a 
crystalline eruption upon the chest, of watery vesicles of a minute 
size, as if a vast collection of vesicles were produced by flirting an 
equal number of very minute drops or particles of boiling water, and 
each particle caused a blister. 

There is another symptom which attends the last stage of 
this complaint, which is more common, but of not less fatal import, 
which is the thrusting of the fingers, nay, almost the hand, into the 
back part of the mouth, as if desirous of removing something from 
the throat. The popular opinion is, that there is a worm irritating 
the back part of the fauces. And we may mention another, which 
we do not remember to have seen noticed, which is, the escape of a 
live worm or worms in the chronic stage of this affliction. If the 
worm come away dead, there is nothing in the circumstance ; but, if 
alive, it is a bad sign. 

The symptoms of this disease are so peculiar, and so well defined 
in the genuine forms, that it will always be recognized without dif- 
ficulty. And, where it imitates other affections, as cholera morbus, 
or dysentery, or diarrhoea, it may be considered as essentially such, 
and requires no difference of treatment. 

The prognosis is far more difficult, since death sometimes happens 
most unexpectedly, and recoveries take place in a state of things 
apparently desperate. 

Treatment. — The disease, as already stated, usually commences 
with a very disordered state of the alimentary canal, and it seems 
to be admitted that our earliest endeavors are to be directed to the 
evacuation of the stomach and bowels. As regards, however, the 
precise course to be pursued, to effect this purj)ose, there is not the 
same unanimity of opinion. Generally purgatives are employed in 
preference to emetics, and especially castor-oil. Cases of a mild 
nature may, undoubtedly, be treated in this way, and particularly 
if laudanum be occasionally added, where there is little or no fever. 
But, in the more violent forms of the disease, attended by vomiting, 
it will be impossible to get such medicines to be retained. It is, 
therefore, necessary that we attempt to allay the irritability of the 
stomach. For this purpose there is nothing so certain or so prompt 



338 CHILDREN AND THEIR DISEASES. 

as an injection of a gill of warm water, in which is dissolved a large 
teaspoonful of common salt ; this is for a child of a year old and up- 
ward, proportionally less for younger. And, however frequent the 
discharges may be per anum, it must not be regarded; the injection 
must be given. If it operate immediately, and bring with it a faecal 
or bilious discharge, the stomach becomes almost immediately 
quieted, and it may then be repeated only whenever the vomiting 
may be severe. Should it not bring any thing off, it must be re- 
peated, and an attempt made to force it high into the bowels, or, 
should the vomiting not -cease, we must again have recourse to it. 

This repetition of the injection will either procure the discharge 
required, or it will produce a most salutary irritation of the rectum, 
on which its chief efficacy depends. We should wish this fact to be 
remembered, for a common injection of molasses, oil, and water, will 
do little or no good, though it may procure a stool, as it lacks the 
stimulating ingredient, the salt, on which its virtue depends. So 
decided and effective is this simple plan, that we have a hundred 
times seen it relieve entirely, almost without the aid of any other 
remedy. 

The great object in cholera infantum is to tranquillize the 
stomach. If the disease have been provoked by any irritating mat- 
ter in the stomach itself, it should be our first endeavor to remove 
it, by encouraging the puking by draughts of warm water, or even 
cold water, where the warm will not be taken, until no foreign sub- 
stance appears in the matter thrown up, but do not administer an 
emetic ; for, so long as Nature continues her efforts to dislodge the 
offensive substance, it cannot be required, as she will certainly suc- 
ceed if she be aided by warm water. 

When this complaint attacks very young children, nearly the 
same plan should be pursued, that is, an injection of the same ma- 
terials must be given, of nearly the same strength, but of less bulk, 
and this repeated when necessary ; or, should the first not succeed 
in allaying the irritation of the stomach, it should be repeated in 
half an hour. A teaspoonful of strong coffee, without sugar or 
milk, every fifteen minutes, should be given, especially to very 
young children, but all ages would profit by it in larger doses. 

In the commencement of this disease the temporizing remedies, 
as the alkalies, the absorbents, or external irritants, are of not the 
smallest service. At this time also, discard all strong-smelling sub- 
stances from the room, and especially from the stomach within, or 
the belly without, as mint, spices, brandy, gin, etc. ; they are ex- 
tremely offensive through the medium of the olfactory nerves. 

If the stomach have not been tranquillized by the injection, or the 



CHOLERA INFANTUM. 339 

strong coffee, immediately commence with minute doses of calo- 
mel : 

Calomel, 3- grains. 

"White sugar, 6 grains. 

Mix, and make into twelve powders. 

One of these powders is thrown dry into the child's mouth every 
hour, until the bowels are decidedly operated on by them ; this may 
be known by the stools being more copious, less frequent, and of a 
dark-green color, with a tenacious slime of the same, or nearly the 
same tone of color. When this change is observed, the powders are 
given much less frequently, say, once in two, three, or four hours, 
as the symptoms may have abated or proved refractory. After the 
bowels have been well evacuated, give an injection with laudanum 
proportioned to the age of the child, provided there is not too much 
fever. With this given in the evening, the child may rest at night. 

Should the symptoms continue, renew the treatment of the pre- 
vious day, until similar effects be produced, and the laudanum-injec- 
tion at night ; treat pretty much after this plan the first or acute 
form of the disease. If much fever attend, with great gastric dis- 
tress, decided advantage may follow the application of leeches over 
the region of the stomach. 

Should irritation of stomach continue, and the legs and feet be- 
come cold, much good is derived from having the legs rubbed with 
mustard and warm vinegar, or Cayenne pepper and warm brandy, 
until the action of the skin be excited. But, from what has been 
said, it will appear that the chief reliance is upon the use of calomel. 
Though some give this article in greater quantities, the minute doses 
directed above will be found sufficient to quiet the irritation of the 
stomach and bowels, and to make a decided impression on the 
hepatic circulation, to invigorate or calm its actions, and thus re- 
store the equilibrium in the distribution of the blood, which is essen- 
tial to the performance of its natural functions. 

Having thoroughly evacuated the intestines and reestablished 
healthy secretions, we are to desist from purges ; we should be con- 
tent with keeping the bowels in a soluble state only, unless there is 
evidence of reaccumulations of bilious and fouler contents, or of 
hepatic torpor and congestion, when the same course is to be re- 
newed. But, if irritation be excessive, and, as usual, productive of 
frequent and painful discharges, we may, with much advantage, ad- 
minister anodyne injections three or four times in the course of the 
twenty-four hours, after having applied a few leeches to the region 
of the stomach. These remedies will, in most cases, certainly calm 
the intestinal canal ; and, as soon as this happens, the acrid dis- 



340 CHILDREN AND THEIR DISEASES. 

charges, together with the other symptoms, very generally cease to 
he troublesome. Yet it will occasionally be necessary to administer 
a mild purgative, to remove oppressive accumulations when they 
manifestly exist ; for this purpose castor-oil is best. 

In addition to what has already been advised for the manage- 
ment of this disease, be attentive to the means calculated to make a 
direct impression on the skin. For this purpose the occasional use 
of the warm bath is highly important. The effects of the bath are 
not lasting, and hence it is required to be repeated daily, or even 
oftener. It may be rendered more effectual where there is much 
cutaneous insensibility, by adding to it salt, mustard, or brandy, 
and, upon coming out, to employ frictions, etc. 

This plan, however, proving unsuccessful, it must be intermitted, 
and, the bowels continuing highly irritated, with bloody evacua- 
tions, we may try the oleaginous mixture, consisting of castor-oil, 
gum-arabic, and laudanum ; or what, perhaps, is still better, melted 
butter, or a union of sugar of lead, ipecacuanha, and opium. The 
lead here is occasionally very efficacious. 

In the course of a few days in some instances, and in others a 
week or more, the disease passes into the nature of diarrhoea, which, 
however, is attended by a slight degree of tormina and tenesmus. 
It is also usual, at this time, to find the stomach greatly debilitated, 
with a loss of the power of digestion, and so irritable as hardly to 
retain any description of nourishment. At this time also the stools 
are apt to become very watery and green, manifesting the predomi- 
nance of acid. The remedies proper, under such circumstances, 
consist chiefly of the cretaceous and alkaline preparations, variously 
combined. They may be prescribed as follows : 

Prepared chalk, . . . . . . . . 1-J drachms. 

Gum-arabic, . ... . . . . . 1 drachm. 

White sugar, 1 drachm. 

Laudanum, .10 drops. 

"Water, 3 ounces. 

Mix. Give a tablespoonful, or less, adapting the dose to the age, and ac- 
cording to the quantity of laudanum. 
Or make the same mixture with thirty grains of carbonate of 
soda, instead of the above quantity of prepared chalk. 

A drop of the oil of cinnamon may be advantageously added 
sometimes to either form of the mixture. Lime-water and milk may 
be also usefully employed. 

At this period of the disease preparations of rhubarb are some- 
times resorted to with advantage. The spiced or simple syrup of 
rhubarb may be given, combined with small doses of laudanum. In 
the use of these preparations the dose is to be small, and repeated 



CHOLERA INFANTUM. 341 

at stated intervals, so as to attain rather the tonic or astringent 
than the purgative effect of this medicine. 

As the disease advances it loses most or all of its acute or pain- 
ful symptoms, and becomes a colliquative diarrhoea, and so profuse 
as to produce from ten to twenty stools in the twenty-four hours. 

The treatment of this case is similar to that of chronic diar- 
rhoea; combinations of chalk, with the tincture of kino, or with an 
infusion of galls and laudanum, are worthy of confidence. The 
columbo in infusion has much reputation. An infusion of logwood 
has also been employed. The decoction of pomegranate bark, or 
flowers, is said to be of great service. The dose of each of these 
preparations is nearly the same — about a dessert-spoonful to children 
above a year old, and less for a younger. A strong infusion of the 
dew or blackberry root is said by many to be useful. 

Even here, however, calomel is serviceable, when there are marks 
of hepatic congestion, or want of bilious discharges, or the presence 
of vitiated humors. Exactly under similar circumstances, and espe- 
cially if the mucous tissue of the bowels be much disordered, as is 
manifested by the loaded tongue and slimy stools, the spirit of 
turpentine has been found highly beneficial, and has succeeded 
when all hope had been abandoned. The dose is from five to twenty 
drops three or four times a day in sweetened cold water. The occa- 
sional use of laudanum, when there is pain, is absolutely necessary ; 
a flannel roller around the abdomen is sometimes productive of sig- 
nal benefit. 

This brings us to the consideration of regimen. In the com- 
mencement of the disease the diet should consist exclusively of 
breast-milk, which is of such importance, that a nurse ought to be 
procured when the child has been weaned. It will of itself some- 
times cure the disease. Caution, however, is necessary even here, 
as the child, from excessive thirst, may demand the breast too fre- 
quently, and thus overload its stomach ; the child, therefore, must 
not be permitted to suck too much or too often. If thirst be im- 
portunate, cold gum-arabic water may be given in small quantities 
frequently, instead of the often nursing. But, if the child will not 
take the breast, let it be fed on diluted sweetened milk, or barley or 
rice-water and milk, or gum-arabic tea. These will serve also for 
drink. But balm or marsh-mallows tea, soda-water, and burned 
bread and water, may also be directed for this purpose. In the ad- 
vanced stages the farinaceous articles may be employed, as very 
thin arrow-root, tapioca, sago, rice, or boiled flour. Extreme de- 
bility of the stomach and bowels existing, and no fever present, a 
little ham or salt fish may be allowed. 



34:2 CHILDREN AND THEIR DISEASES. 

Yet, the only remedy which is sovereign, and nearly unfailing, is 
a change of air. As long as the child remains exposed to the oper- 
ation of the causes of the disease, we may palliate or suspend its 
career, but can hardly ever make a radical cure ; relapse upon re- 
lapse takes place, until the strength is finally extinguished. 

Great benefit is gained by a removal from the city to the country, 
in every stage of the complaint. There is nothing so effectual. As 
soon, almost, as the child gets into the country air, there is a change. 
Where we cannot have a country residence entirely, it will be useful 
to ride out daily, or twice a day. Crossing the river is often found 
highly beneficial. 

To prevent the disease : 

1. Never permit a delicate child to be weaned within the year, 
when practicable to prevent it. No food is so salutary as the 
natural milk. As respects this complaint, weaning predisposes to 
its attacks. 

2. Direct the wearing of flannel next to the skin, and worsted 
stockings. The great benefit of this system is experienced by 
grown persons prone to intestinal complaints, and its utility is no 
less in children. 

3. Duly regulate the diet, let an excess of fruit be avoided, and 
absolutely abstain from unripe or unwholesome kinds. The proper 
food of a child is, substantially, milk with farinaceous matter, such 
as arrow-root, rice biscuits, etc. After a few months, provided it 
has teeth, it will be useful to accustom it to a little animal food. 
It strengthens the powers of digestion and the general tone of the 
alimentary canal. 

4. During dentition let the gums be frequently examined, and, 
if any appearance of swelling or inflammation exist in them, they 
must be lanced. Dentition, during hot weather, is but too apt to 
excite cholera, and if the complaint exist it never fails to aggra- 
vate it. 

5. Let the child, when practicable, be removed to the country, 
but not too early in the season. 



PNEUMONIA, PLETTKISY, AND BRONCHITIS. 

These inflammations of the chest occur in children of all ages, 
and are all very dangerous. Commonly, there are but few signs to 
direct attention to the chest, except in bronchitis, where there is 
always cough, and thus the other two are frequently mistaken for 
fevers. When children have taken cold, and are made very ill by 
it, and when a fever comes on them every afternoon, suspect one or 



PNEUMONIA, PLEURISY, AND BRONCHITIS. , 343 

another of the above diseases. If there is bronchitis, there will be 
cough to distinguish it. In pneumonia, alse, there will be cough, but 
it is not so prominent a feature. The vibration of the chest during 
coughing or crying, observed by placing the palm against the ribs, 
is an important sign. In pleurisy, children complain of the pain in 
the side, if they are old enough. Younger ones lie very quiet and 
dislike to be moved, because of the pain that motion causes. Pleu- 
risy gives many symptoms that resemble. those of disease of the brain, 
but the disease of the brain it resembles will not come on so sud- 
denly if the child was previously well. 

For these diseases the treatment is essentially the same. Cover 
the chest with onion draughts or poultices of linseed-meal, keep the 
bowels regular, and give diaphoretics, and, in the case of bronchitis, 
expectorants also. So soon as the symptoms peculiar to the disease 
appear to yield, give tonics. 

Begin the treatment with a dose of calomel and Dover's powder 
adapted to the age.- For a child of one year, a grain of calomel and 
quarter of a grain of Dover's powder. Double this dose for a child of 
three years. The spirit us mindereri is an efficient diaphoretic, but 
the best sedative diaphoretic and expectorant together is tartar- 
emetic ; give it in exceedingly small doses, say the sixtieth part of 
a grain. Dissolve one grain in an ounce of water, and give six to 
twelve drops once in two or three hours. If it vomits a little, all the 
better, but do not push the vomiting-dose. 



For particular account of some formidable diseases of children, 
see, on other pages, Croup, Hydrocephalus, Worms, Chorea, 
Whooping-cough, Measles, Scarlet Fever, Rickets, Convulsions, 
Vaccination, etc. 

23 



MATEEIA MEDICA. 



EMETICS. 

These are medicines capable of exciting vomiting, and this inde- 
pendently of any effort of the stomach arising from quantity or fla- 
vor. Susceptibility to the action of this useful class of remedies 
varies greatly in different individuals, and is considerably modified 
by the nature of the disease for which they may be administered. 
When there is any morbid affection depending on or in connection 
with overdistention of the stomach, emetics are very useful, as 
the vomiting which they excite generally affords speedy relief; thus, 
in impaired appetite, excess of acidity, intoxication, and poison, 
they are constantly resorted to, as well as in jaundice arising from 
obstruction of the biliary ducts ; in catarrh, and phthisis, and dys- 
entery, where there is much mucus of which it is desirable to relieve 
the passages. They are also useful in nauseating doses in dropsies, 
haemorrhages, constriction, and in any cases in which it is desirable 
to relax the muscular or other tissues. Emetics are dangerous or 
hurtful when there is much debility, as their frequent use lowers 
the tone of the system ; also where there is a determination of blood 
to the head, especially in patients of plethoric habit, in visceral in- 
flammation, the advanced stages of pregnancy, hernia, and prolapsus 
uteri. An emetic should always be administered in a fluid form, 
and its operation will be promoted by drinking some tepid diluent, 
such as warm water, or bitter infusion, such as chamomile-tea. 

The principal emetics given to promote full and free vomiting 
are, ipecacuanha-powder, dose, ten to thirty grains ; tartarized anti- 
mony, of which from one-quarter of a grain to two grains may be 
given ; sulphate of copper, one-quarter to five grains ; sulphate of 
zinc, ten to thirty grains ; the latter is perhaps best in cases of poison- 
ing, and it should be repeated every quarter of an hour, until the 



DIURETICS. 345 

full effect is produced. If neither of the above can be readily ob- 
tained, a teaspoonful of strong mustard may be mixed in warm wa- 
ter and swallowed, or a tablespoonful of common salt ; irritating 
the fauces with a feather, or putting the finger far down the throat, 
will often excite vomiting. It should be borne in mind that min- 
eral act more quickly than vegetable emetics, and that the action 
of either will be more rapid in proportion to the emptiness of the 
stomach. 

In the chest diseases of children, where there is much mucus with- 
out the power to expectorate, emetics are especially serviceable, and 
they may be given frequently ; for very young children ipecacuanha- 
syrup is the best form of administration, from ten drops to thirty, or 
a teaspoonful, according to age. In some cases of incipient disease, 
where there are coldness of the skin, and other symptoms of depres- 
sion, a full dose of ipecacuanha, with about six grains of carbonate 
of ammonia, will have the effect of arousing the system. Cramps and 
spasmodic diseases are often greatly relieved by emetics, and asth- 
ma when nothing else will afford relief. 

CATHARTICS. 

These may be either laxative, purgative, or drastic, according 
to their power of accelerating or increasing the evacuations from the 
bowels ; we append a list of those most used, with their doses : aloes, 
from five to fifteen grains ; colocynth-powder, two to six grains ; 
elaterium (or wild-cucumber), one-half to three grains; gamboge, 
five to twenty grains ; hedge hyssop, from ten to thirty grains ; 
jalap, ten to twenty-five grains ; scammony, ten grains ; submuriate 
of mercury (calomel), one to twelve grains; castor-oil, one half to 
one ounce ; rhubarb, ten to twenty grains ; senna, twenty to thirty 
grains ; extract of dandelion, three to ten grains ; carbonate of mag- 
nesia, one-half to two drachms ; sulphate of magnesia (Epsom salts), 
one-half to two ounces-; muriate of soda (common salt), ten to sixty 
grains ; tartrate of potash, two to eight drachms ; supertartrate 
(cream of tartar), one to three drachms; sulphate, one to two 
drachms; supersulphate (polychrist salt), one to six scruples; po- 
tassio-tartrate of soda (Rochelle salt), one to four drachms; Castile 
soap, one to two drachms ; sea water, one-half pint. 

DIURETICS. 

Medicines which augment the urinary discharge ; this effect will 
be produced by any substance which stimulates the secreting vessels 
of the kidneys. All the saline diuretics act in this way ; they pass 



346 MATERIA MEDIC A. 

into the circulation, and appear to exert a specific action upon these 
vessels. The free drinkjng of mild diluents will also have this effect, 
while the application of external heat to the body will exert a con- 
trary influence by exciting perspiration, which is an increased cuta- 
neous secretion. Diuretics- are mainly adjuncts. Thus, in dropsy, 
in which they are chiefly employed, if perfectly successful, they do 
but remove for a time a portion of the effusive fluid, which quickly 
collects again : they are sometimes useful in calculous affections, 
also in gonorrhoea, and they have a tendency to check profuse per- 
spiration, and diminish plethora ; but their frequent and constant use 
is very weakening to the system. The medicines o'f this class chiefly 
used are broom (genista), the tops in powder, dose, one to three 
scruples; bitter-sweet (dulcamara), same dose; dandelion, extract 
ten grains to one-half a drachm; foxglove (digitalis), leaves and 
seed, one-half to three grains ; juniper berries and tops, one to three 
scruples ; meadow saffron (colchicum), root and seed, one-half to 
three grains ; sarsaparilla, root powdered, one to two drachms ; 
snake-root (seneka), one to three scruples ; squills, root powdered, 
one to three grains ; Spanish flies (cantharides), one-half to three 
grains ; potash, acetate of, one to three scruples ; carbonate, ten 
to thirty grains ; nitrate, five to ten grains ; subcarbonate, ten to 
three grains; supertartrate (cream of tartar), two drachms to one 
ounce; spirits of nitric ether (sweet spirits of nitre), one-half of a 
drachm to two drachms ; tar-water, one-quarter to one-half a pint ; 
turpentine, five drops to one-half a drachm ; gin ; common and chalyb- 
eate waters, etc. Among the wild plants possessing diuretic prop- 
erties, the broom and dandelion may be mentioned as the most com- 
mon, and therefore accessible to persons in the country. (For full 
account of the former, see dandelion / of the latter, genista.) Gin, 
spirits of nitre, and turpentine, may always be readily procured, and 
are as certain in their operation as any ; but they should not be taken 
where there is much tendency to irritation. 



DIAPHORETICS. 

These are medicines which increase the natural exhalations of 
the skin ; if they are not so powerful as to occasion actual perspira- 
tion, they are called sudorifics. The difference in the operation of 
these two classes of remedies is not in kind, but in degree only. 
Diaphoretics may be divided into five orders, viz. : 

1. Pungent, as, the volatile salts and essential oils, which are 
more especially adapted for aged persons, on whom other diapho- 
retics have little effect. 



EXPECTORANTS. 347 

2. Calef orient, which excite a degree of warmth in the parts to 
which they are applied, and, like the last, are given where the cir- 
culation is low and languid. Serpentaria and guaiacum may b.e 
mentioned as common examples of this order. 

3. Stimulant, best fitted for vigorous and plethoric habits ; such 
are the preparations of antimony and mercury. 

4. Antispasmodic, such as camphor, musk, and opium, given to 
promote a diaphoresis when the circulation is too full and rapid. 

5. Diluent, such as water, barley-water, thin gruel, whey, etc. 
given when it is desirable to promote perspiration, and so check the 
course of. active diseases. 

The following are among the principal diaphoretics : Antimony, 
oxide of, dose, one grain to ten ; powder of, five to twenty grains ; 
tartarized, one-eighth to one grain. Camphor, five to twenty 
grains ; Dover's powder, five to twenty grains ; guaiacum, resin, or 
wood, ten to thirty grains ; acetate of ammonia, liquor of, one-half 
to one drachm; carbonate of ammonia, liquor of, one-half to one 
drachm ; nitrate of potash, five to ten grains ; spirit of ammonia, 
one-half to one drachm ; nitric ether, ten to twenty drops, etc. 

The efficacy of diaphoretics is much increased by combinations 
with each other. 

EXPECTORANTS. 

These are medicines for promoting the discharge of mucous or 
other matters from the trachea and its branches. Expectorant 
medicines may generally be arranged under the following four 
heads : 

1. Nauseating, as ammoniacum, garlic, and squills, which are 
most suitable for the aged and phlegmatic. 

2. Stimulating, as horehound, which is best adapted for the 
young and irritable. 

3. Antispasmodic, as blistering substances, hot fomentations, 
foot-baths, etc., most suitable for the plethoric and irritable, and 
those liable to spasmodic affections. 

4. Irritating, as fumes of tobacco and acrid vapors, adapted for 
those past the period of growth, and those who have evident marks 
of torpor, in the lungs in particular, or in the system generally. 

As expectorant medicines, we chiefly use ammoniacum gum, 
dose ten to thirty grains ; antimony, various preparations, but 
chiefly the wine, dose five to ten minims, with other medicines ; 
balsam of tolu, five to ten drops on sugar ; benzoin, compound tinc- 
ture, about half a drachm ; dulcamara, decoction, one drachm to an 
ounce. 



348 MATERIA MEDIC A. 

A twofold action may be traced in these remedies : first, they 
remove the constriction of the vessels by the relaxation caused by 
the nausea they excite ; and, by their stimulating after-action, they 
restore the natural secretions, and so change an unhealthy for a 
healthy condition of the vessels. 

The following formula of expectorant medicines may be recom 
mended as safe and efficacious. For mixture — 

Take of ipecacuanha-wine, 2 drachms. 

Syrup of tolu, 4 drachms. 

Compound tragacanth-powder, ... 2 drachms. 

"Water sufficient to make six ounces. 
For a child, one, for a grown person, two, tablespoonfuls every four hours. 

In the latter case, two drachms of compound tincture of camphor 
may be added to the mixture, and two drachms of vinegar of squills 
if the expectoration is difficult. 
For pills- 
Take of compound squill-pill, 1 drachm. 

Compound ipecacuanha-powder, .... 1 drachm. 
Mix, and make into twenty-four pills ; one every four or six hours. 

For an electuary, rub down one ounce of spermaceti, with a few 
drops of spirits of wine ; mix with an equal quantity of powdered 
gum-acacia ; then add common vinegar, syrup of poppies, and 
almond-oil, of each, half an ounce. Put the whole into a gallipot, 
and give a teaspoonful when the cough is troublesome ; excellent 
for children, who will commonly take it eagerly on account of its 
sweetness. 

All emetics are expectorants when given in smaller than the 
emetic doses, as lobelia, antimony, etc. 



EMMENAGOGUES. 

These are medicines which possess the power of promoting the 
monthly discharge, which is so essential to a state of health in cer- 
tain conditions of the female system. They may be placed under 
four distinct heads, viz. : 

1. Stimulating, as antimonial and mercurial preparations, which 
are chiefly given to young persons, and those who manifest peculiar 
insensibility of the uterus. 

2. Irritant, as aloes, savine, and Spanish flies, most useful in tor- 
pid and chlorotic habits. 

3. Tonic, as preparations of iron, cold baths, and exercise, best 
suited for lax and phlegmatic habits. 



ANTISPASMODICS.— ANTHELMINTICS. 3^9 

4. Antispasmodic, as assafcetida, castor, and pediluvia. Weak, 
delicate, and irritable constitutions, are those for which these are 
best adapted. 

Some of these medicines appear to act upon the womb by stimu- 
lating the surrounding organs ; others by their action on the ner- 
vous system ; and others, again, by their tonic influence upon the 
system at large. The first-named action is that of aloes; the 
second, assafcetida ; and the third, iron. 

The emmenagogues which are principally used are : aloes, five to 
fifteen grains ; ammonia (carbonate and subcarbonate), dose, five to 
twenty grains ; aristolochia, ten to thirty grains ; cantharides, one 
to two grains ; electricity ; ergot of rye, five to six grains ; elemi- 
gum, ten to thirty grains ; galbanum, ten to thirty grains ; iron, 
rust of, tartarized and vitriolized, ten to thirty grains ; iron, sulphate 
of, One to two grains ; iron, citrate of, five to ten grains ; madder, 
one-half drachm to a drachm ; myrrh, ten grains to one drachm ; 
opoponax, ten to thirty grains ; and savine, ten to thirty grains. 

ANTISPASMODICS. 

As spasms may arise from a variety of causes, so must the reme- 
dies for them be numerous and diverse in character. Thus, narcotics, 
sedatives, stimulants, nauseants, aperients, stomachics, tonics, blood- 
letting, the hot bath, and application of dry heat, all, at different times, 
come under the above denomination ; but, as tjie immediate cause of 
spasms is commonly wind in the internal cavities or passages of the 
body, those medicines which have a direct action thereon are espe- 
cially antispasmodic : such are assafcetida, valerian, galbanum, ether, 
essential oils of mint, anise, and dill, ginger, spirits of ammonia, and 
brandy. 

ANTHELMINTICS. 

Medicines which cause the expulsion of worms from the stomach 
and intestines. These mostly act mechanically, dislodging the worms 
by the roughness of their particles, or by their cathartic operation. 
Some appear to owe this beneficial action wholly to their bitter 
properties, which prove noxious to the creatures, or by restoring 
the tone of the stomach and removing that debility of the digestive 
organs, which prevented the proper assimilation of food and con- 
duced to the generation of the animals. Anthelmintics are best 
administered upon an empty stomach ; hence it is common to pre- 
pare the way for them by an emetic. The principal are pink-root, 
male fern, turpentine, kousso, pumpkin-seed, and santonin. 



350 MATERIA MEDIC A. 



ALTERATIVES. 



A class of medicines whose object is to effect a gradual change 
in the state and condition of the functions, secretions, etc., and estab- 
lish the healthy habit, which has somehow become deranged. 

An alterative medicine, then, is supposed to be one which pro- 
duces a new effect, and thus alters or diverts the attention of the 
system (if we may so speak) from the original disease ; it is gener- 
ally directed, or intended to act, upon the immediate seat of mis- 
chief, as the liver, the blood, etc. Small doses and frequent is the 
general rule with regard to the administration of alteratives, and in 
this way some of our most active and even poisonous drugs are 
employed to produce very beneficial results. It is properly through 
the medium of the excretions and secretions that alteratives act. 
They are taken from all classes of medicines, mineral as well as 
vegetable; thus, mercury and ipecacuanha, the former commonly 
combined with chalk, as in the hydrargyri cum creta of the phar- 
macopoeia, and the latter with opium and an alkali, as in the pulvis 
ipecac, comp., or Dover's powders, both of which see. 



TONICS. 

Medicines which restore the tension and vigor of the muscular 
fibre when it is weakened and relaxed. They may be divided into 
classes, as thus : those which act indirectly by passing into the 
blood, and exerting their influence through the circulation. These 
are the bitter tonics, such as calumba, chamomile, cinchona, gentian, 
quassia, quinine, salicine, etc. The direct tonics include iron in its 
various forms, the mineral and vegetable acids. Among non-medi- 
cal tonics may be named, cold as variously applied, exercise, a pure 
and bracing air, and mental emotions of a pleasant and stimulating 
character. See also heads of the several diseases, among whose 
remedies tonics have a prominent place. Tonicity is a term some- 
times used to denote strength and elasticity of the muscular fibre. 

ANODYNES. 

Medicines which assuage pain. These medicines act by dimin- 
ishing sensibility. The following is a list of the medicines of this 
class which are principally used, with their doses ; a full account of 
their nature and uses will be found under their several heads : cam- 
phor, five to twenty grains ; compound spirits of sulphuric ether, 
one-half a drachm to two drachms ; extract of aconite, one-quarter 



NARCOTICS. 351 

to three-quarters of a grain; of belladonna, one-half to two grains; 
of conium, three to twenty grains ; of digitalis, one-half to one grain ; 
of hyoscyamus, two to ten grains ; of lettuce, three to ten grains ; 
of hop, five grains to one drachm ; of opium, one-half to five grains ; 
of poppy, two to twenty grains; of stramonium, two to ten grains ; 
morphine, acetate and muriate of, from one-quarter to one-half a 
grain. Pills of conium, of opium, of ipecacuanha with opium, of 
soap with opium, and several other pills into the composition of 
which opiates enter, may be included ; the dose is generally from 
five to ten grains. Powders of burnt hartshorn, and of chalk with 
opium ; doses of the former, five to twenty grains, of the latter, one 
to two scruples. Compound powder of ipecacuanha, commonly called 
Dover's powder, five to twenty grains, and tobacco, dried leaves, 
one-half a grain to one grain, seldom used. For children, syrup of 
poppies and Godfrey's cordial are much used, the latter especially 
to a very mischievous extent. Opiates should always be given with 
great caution, to the young especially ; in the earlier stages of life they 
are seldom really needed. They are a great blessing when properly 
used, but too often turned by abuse into a curse, as the examples 
of excessive tobacco-smokers and opium-eaters frequently prove. In 
many acute and some chronic forms of disease, when the frame is 
racked with pain, or the brain excited to unnatural activity, it is 
often necessary to administer anodynes, and their soothing effect is 
felt like a foretaste of heaven. To the aged, who are weary and yet 
wakeful, they are sometimes a balm and a consolation, which it 
would be cruel to deny them ; but, as we said before, the child sel- 
dom requires them, and, if given at all, it should be only in the mild- 
est form, unless under the direction of the medical adviser. 



NARCOTICS. 

Medicines which induce sleep or stupor. They are the same gen- 
erally as the sedatives, but the action of the medicine is pushed further. 
The following are the principal narcotics which are used in medical 
practice : belladonna, camphor, conium (hemlock), hyoscyamus 
(henbane), Indian hemp, lactucarium (lettuce), morphia, opium, pop- 
py, stramonium. They are all dangerous medicines, for one who is 
not well acquainted with their uses and effects, to meddle with ; a 
reference to their several heads will show in what cases and how 
they may be given. 

The N~arcotico-IrHtants differ from the simple narcotics in hav- 
ing a direct action on the spinal marrow and nerves, as indicated by 
paralysis and convulsions ; they also affect both the brain and ali- 



352 MATERIA MEDIC A. 

mentary canal ; the chief poisons of this class are — cocculus indicus, 
colchicum or meadow saffron, digitalis or foxglove, hellebore, nux 
vomica, and strychnine ; the poisonous mushrooms, aconite, bella- 
donna, and conium, ought also to be included. 

The simple Narcotic Poisons are chiefly opium and its prepara- 
tions, alcohol and ether, although under this denomination all those 
narcotics previously mentioned might be classed. (For symptoms of 
poisoning by these, and modes of treatment, see Poisons.) 



STIMULANTS. 

Medicines which quicken or augment the functions of the bodily 
organs. They may be divided into two classes : 1. Those which 
produce a general stimulant effect upon the system, Antispasmod- 
ics, Astringents, Narcotics, and Tonics (all of which see) ; 2. Those 
which produce an effect upon particular parts of the system : these 
have often been called vacuants, because they occasion a greater 
secretion of the organs on which they act ; these will be found under 
the several heads of Emetics, Emmenagogues, Epispastics, Errhines, 
Cathartics, Diaphoretics, Diuretics, etc. 

Of the benefit of stimulants in certain cases and stages of disease, 
and therefore the propriety of their administration, there can be no 
question, although some have expressed doubts upon the subject. 
Those only who have had to deal with cases of low typhoid fevers, 
and utter prostration and exhaustion of nervous power, can rightly 
estimate their value. 

ANTACIDS. 

Medicines which are intended to correct acidity of the stomach 
and bowels ; their action is purely chemical ; they combine with the 
acid and neutralize it, but do nothing to prevent its regeneration ; 
therefore they are simply palliatives, and cannot be depended upon 
for restoring the tone of the impaired organs, whose powers a long 
continuance of them is apt to enfeeble. Ammonia, chalk, lime, and 
all cretaceous matter, magnesia, and the alkalies, potash and soda, 
are the chief antacids, or absorbents. There are many forms of 
preparations, but the action is pretty uniform. Ammonia, in its 
various combinations, is useful where acidity in the stomach exists 
with flatulency and tendency to cramp or colic. Magnesia and the 
preparations of chalk or lime are best when acid is present in the 
bowels, causing loose evacuations, griping-pains, etc., and this be- 
cause they pass down the alimentary canal, and into the seat of mis- 
chief, without losing their absorbent powers. Where an alkaline 



ASTRINGENTS. 



353 



test shows acidity in the urine, preparations of potash are most suit- 
able for administration, as they are more readily soluble than soda. 



ASTRINGENTS. 

Remedies which act by contracting the animal fibres, and render- 
ing the solids denser and firmer; hence, by causing greater com- 
pression of the nervous fibres, they lessen morbid sensibility or irri- 
tability, and thus serve to diminish excessive discharges, such as 
fluxes, haemorrhages, diarrhoea, etc. (which see). 

The following is an alphabetical list of the chief astringents used, 
with their respective doses : 



Acid, sulphuric, dilute, . 

" gallic, 
Alum . 

" dried, 
Arsenic, oxide of, . 
Bistort, root of, . 

Catechu, 

Copper, sulphate of, . 
Galls, 

" tincture of, . 
Iron, sulphate of, 

" filings of, . 

" rust of, . 

" muriated tincture of, . 
Kino, tincture of, . 

" powder of, 
Lead, superacetate of, . 
Lime-water, 
Logwood, 

" extract of, . 

Pomegranate, flowers and bark, 
Roses, red, the petals of, 

" damask, 
Quicksilver, nitrate of, 
Sage, leaves of, 
Simarobar, bark of, 
Saunders red, the wood, 
Tannin, .... 
Tormentil, the root, 
Whortleberry-leaves, 



dose 10 

" 5 

" 10 

" 5 

" A 

« 10 

« 10 

" i 

" 2 

" 1 

" 1 

" 5 

" 2 

" 10 

" 10 

" 10 

" i 

" 2 

" 1 

« 10 

" 1 

" 1 

" 1 

" 4 

" 10 

" i 

" l 

" 5 

" 10 

" 10 



drops to 1 
grains to 10 
grains to 1 
grains to 1 
grain to J 
grains to 1 
grains to 1 
grain to 5 
grains to 10 
drachm to 2 
grain to 2 
grains to In- 
grains to 10 
drops to 20 
drops to 20 
grains to -J 
grain to 2 
ounces to J 
scruple to 1 
grains to 1 
scruple to 1 
scruple to 1 
scruple to 1 
grain to 2 
to 1 
to J- 
to \ 



grains 

grain 

grain 



grains to 10 
grains to 1 
grains to 1 



drachm. 

grains. 

scruple. 

scruple. 

grain. 

drachm. 

scruple. 

grains. 

grains. 

drachms. 

grains. 

drachms. 

grains. 

drops. 

drops. 

drachm. 

grains. 

pint. 

drachm. 

drachm. 

drachm. 

drachm. 

drachm. 

grains. 

drachm. 

drachm. 

drachm. 

grains. 

drachm. 

drachm. 



354: MATERIA MEDIC A. 

The following may be quoted as good forms of administration 
and application in most cases where astringents are required : 
For mixture — 

Take of muriated tincture of iron, 2 drachms. 

Pure water, or infusion of quassia, . . . .12 ounces. 
Two tablespoonfuls three times a day. 

For pills — 

Take superacetate of lead, 12 grains. 

Opium, 4 grains. 

Extract of hemlock or gentian (as the case may require), 2 scruples. 
Make into twelve pills ; one three times a day with a draught of vinegar and 
water. 



For gargle — 

Infusion of roses, 6 ounces. 

Alum, 1 scruple. 

Oxymel, or syrup, ........ 6 drachms. 



ESCHAROTICS. 

These are substances employed to produce the above result, be- 
cause they have the power of eroding or dissolving animal solids, 
which they do either by combining therewith, and forming a soft 
pulp, or by causing the elements to enter into new combinations, 
and so destroying their cohesion and altering their composition. 
Thus, their operation may in general be considered as purely chemi- 
cal ; produced in most cases by some peculiar affinity existing be- 
tween them and the solids or fluids, with which they are brought 
into contact ; so, nitrate of silver, one of our commonest escharotics, 
by the action of the muriatic acid contained in all animal fluids, is 
decomposed, and covers any part, to which it is applied, with a 
whitish film, which is, in fact, a muriate of silver. Escharotics dif- 
fer greatly in the energy of their actions, some eroding merely the 
cuticle or external surface of the skin, as nitrate of silver and sul- 
phate of copper; others, as caustic potash, and quick-lime, decom- 
posing the animal matters to a considerable depth ; with some, too, 
there is, besides the chemical, a specific action, not obtainable from 
others ; of that class, arsenic may be named as an example. 

We commonly find escharotics classed under two heads, viz., 
the Potential Cauterants, and the Actual Cautery, the former being, 
as before observed, chiefly chemical agents. Among those most 



DEMULCENTS. 355 

commonly employed to produce counter-irritation, or remove fun- 
goid or morbid growths of any kind, are the strong mineral acids, 
such as sulphuric and nitric ; pure alkalies, and some metallic salts, 
especially nitrate of silver. The actual cauterants, such as hot 
water or vapor, or heated metal, are used for their primary or sec- 
ondary actions ; the first being the immediate destruction of the 
part to which they are applied, and the second to stimulate and 
arouse the nervous energy of the system, so as to enable it the better 
to meet and combat any disease with which it may be attacked. 
Atony and laxity of the muscular system, neuralgic pains, and even 
paralysis, are sometimes materially relieved by these means. 



DEMULCENTS. 

Medicines which have softening and soothing properties, render- 
ing them especially suitable for obviating the action of acrid and 
stimulant matters, not so much by correcting or changing their 
nature, as by involving them, or the delicate tissues exposed to their 
action, in a mild and viscid fluid. Their chief employment is in 
catarrh, diarrhoea, gonorrhoea, dysentery, gravel, stone, etc. They 
may generally be divided into two divisions, mucilages and ex- 
pressed oils: in the first we have almonds, colt'sfoot, arabic and 
several other gums, linseeds, mallows, liquorice-root, barley, oats, 
and wheat, sago and starch. Among the latter are most European 
and many foreign oils, fat, and other animal substances, including 
hartshorn shavings, gelatine and isinglass, spermaceti and wax. 
The following is a pleasant and eflicacious demulcent draught, suit- 
able where there is fever : 

Almond-mixture, 1 ounce. 

Carbonate of potash, .10 grains. 

Syrup of poppies, 1 drachm. 

Mix, and add a tablespoonful of lemon-juice, or ten grains of citric acid, and 
drink while in a state of effervescence. 

As a form for a cough-mixture, easily prepared, take oil of al- 
monds six drachms, liquor of potash one drachm, shake well and 
make up to eight ounces, with rose or plain water ; sweeten with 
syrup of poppies and add paregoric-elixir two drachms, or tincture 
of squills, if required to be more expectorant. The best demulcent 
enema is made by dissolving six drachms of starch in half a pint of 
hot water ; add one drachm of tincture of opium if necessary. 



356 MATERIA MEDIC A. 



EPSOM SALTS {Sulphate of Magnesia). 

This is perhaps the most generally used of all known purgatives — 
certainly of all those of a saline nature; yet considerable mischief 
undoubtedly results from its common and indiscriminate use ; for, 
although it is well suited for persons of a full, plethoric habit, and is 
a most valuable medicine in many diseases — being tolerably certain 
in its action, griping but little, if at all, and producing free, watery 
discharges — yet it is too weakening to be taken frequently by those 
of delicate constitution, and especially when swallowed, as it most 
commonly is, in the- form of a strong solution. The flavor being 
very nauseous, it is the great object, with those who are necessitated 
to take it, to make the dose of liquid as small as possible ; but in 
this they greatly err ; in too concentrated a form it induces a dis- 
charge of the serous, or watery portion of the blood, into the bowels, 
and thus seriously debilitates the system, besides causing a tendency 
to constipation, directly its action has ceased. From half a drachm 
to one drachm of these salts, dissolved in a tumbler of water and so 
taken, would have a better effect, and be safer in its operation, than 
five or six times the quanity in a wineglassful of the liquid ; the 
drink is not pleasant, but it may be taken, and the best time is be- 
fore breakfast in the morning. To correct any tendency to griping 
or flatulency, it is best to add something warm and aromatic ; the 
following is a good form of preparation : 

Take of Epsom salts, .... 1 ounce. 

Sliced ginger-root, 2 drachms. 

A few bruised cloves, 

Boiling water, 1 pint. 

Let it stand two hours, then strain into a wine-bottle, and fill up with 
peppermint-water. Dose — a tumblerful every morning, fasting, while 
required. 

Persons suffering from habitual constipation will commonly find 
relief from this remedy, which, however, is scarcely fit for the weak 
and aged, for the reasons already stated. By persons of scrofulous 
habits, Epsom salts, in combination with iron and acid, may be 
taken with advantage, as thus : 

Sulphate of magnesia, 6 drachms. 

Sulphate of iron, 12 grains. 

Diluted sulphuric acid, 1 drachm. 

Plain or peppermint water, 12 ounces. 

Mix, and take one tablespoonful three times a day, 



SENNA. 357 

Perhaps the most agreeable form in which this salt can be admin- 
istered is, dissolved in an infusion of roses ; the mixture may be thus 
prepared : 

Take of sulphate of magnesia, 1 ounce. 

Eed rose-leaves, dried, 3 drachms. 

Boiling water, 1 pint. 

Let it stand two hours, then strain and add 

Diluted sulphuric acid, . . . . 1-J- drachms. 

Lump-sugar, 6 drachms. 

Dose — a wineglassful once or twice a day, or as often as required. 

If there is great debility of the stomach, half a grain of sulphate 
of quinine may be added to each dose of either of the above mix- 
tures which contain acid ; besides acting as a tonic, this appears to 
increase the aperient property. One of the most convenient and 
best occasional purgatives in use is, the Epsom salts in combination 
with senna, a mixture generally known as the black draught. 

We have already spoken of coffee as a good vehicle for the ad- 
ministration of Epsom salts. A" simple infusion, however, of the 
berry will not develop the aroma sufficiently to hide the nauseous 
bitter of the sulphate, of which one ounce, with two and a half 
drachms of ground coffee, should be boiled in a pint of water for 
about two minutes in a glazed vessel : before straining, let the mix- 
ture stand for about ten minutes, then bottle and sweeten to taste; 
a wineglassful or more may be taken when required ; this is a fa- 
vorite formula with the French physicians. 

One ounce of the sulphate of magnesia dissolved in a pint of 
warm water is a good injection for those troubled with ascarides or 
thread-worms : its utility in inflammatory diseases, in small and re- 
peated doses, combined with acetate of ammonia and other febri- 
fuges, is universally acknowledged ; and its consumption among all 
classes of the community (especially the poorer ones) must be truly 
enormous. The small, pointed, transparent, colorless crystals of 
these salts very closely resemble those of oxalic acid — a most viru- 
lent poison ; and fatal accidents have resulted from mistaking one 
for the other ; there is, however, a very simple test — take a small 
crystal, and put it on the tongue : if it have an intensely acid and 
burning taste, it is not Epsom salts, which is simply disagreeable 
and slightly bitter. 

SENNA. 

This name is commonly applied to the dried leaflets of several spe- 
cies of cassia which are found chiefly in Africa and India. But that 



358 MATERIA MEDIC A. 

which is considered as the officinal senna is the produce of the Cassia 
lanceolata and C. obovata. 

This is commonly called Alexandrine senna, from the port at 
which it is shipped, but it is collected in the interior of Upper Egypt ; 
it is commonly adulterated with the leaves of two or three other 
plants, which may be distinguished from it by their greater, length 
and thickness, the absence of visible lateral nerves on the under side, 
and their lighter color; some of them by their downy surface, their 
unbranched lateral nerves running nearly in parallel lines, and by 
their being usually folded lengthways ; this adulteration, which is 
always found more or less in the kind of senna here spoken of, is 
technically called Argel. The Tripoli senna, which is the produce 
of the C. ^Ethiopica, is said to be collected chiefly at Fezzan ; it is 
smaller and more broken than the other kinds, the leaflets being 
more thin and fragile; they are naturally, too, of a more blunt 
rounded form, and as generally imported are much mixed with 
stalks and pieces of fibre. Indian senna is the produce of O. elon- 
gata ; it comes mostly from Arabia, but is shipped at East Indian 
ports ; it is distinguished from the other kinds by its long, narrow 
leaflets ; it is considered the best kind. 

The purgative properties of senna are well known, and it is the 
most commonly employed of all cathartics ; it is sure in its operation, 
but rather heating, and apt to gripe and cause nausea ; therefore, an 
aromatic should generally be given with it. It should not be ad- 
ministered when there are irritation and fever, nor during pregnancy, 
nor the existence of piles. It may be given to children and elderly 
persons quite safely, when a tolerably active purge is required, and 
it is well to combine a saline aperient with it, as in black draught. 
The powdered leaves are sometimes, but not often, administered ; 
the dose varies from half a drachm to two drachms ; the confection, 
a mild laxative, commonly called lenitive electuary, from one to 
four drachms ; the syrup, a good preparation for young children, 
from one to two drachms ; tincture, from one to four drachms ; com- 
pound infusion, an excellent family medicine, from one to three 
ounces. It may be prepared as follows : 

Senna-leaves, .......... 4 drachms. 

Kaisins (stoned), 1 ounce. 

Ginger (bruised), 2 drachms. 

Boiling water, 1 pint. 

Macerate four hours in a covered vessel, and strain. 

A tablespoonful of brandy will add to its stomachic properties, 
and make it keep better ; but, if for young children, this had better 
not be added. The infusion should be kept in a cool place. 



SULPHUR OR BRIMSTONE. 359 

SULPHUR OR BRIMSTONE. 

This useful mineral, which, in one form or another, enters so 
largely into our medical formulary, is one of the most abundant 
constituents of the globe, being a constant element in most animal 
as well as vegetable substances, and existing in the form of metallic 
sulphurets, and in the combination of sulphuric acid with various 
bases, such as lime, magnesia, etc., almost everywhere. " The roll 
sulphur " is merely the mineral fused and cast into moulds ; in " the 
flowers of sulphur," we have it as vaporized by heat and then con- 
densed ; this we call sulphur sublimatum ; in " milk of sulphur," so 
called from its whiteness, it is levigated and washed ; this is the lac 
sulphur is of the pharmacopoeia, and is the best form for internal ad- 
ministration, being the most pure, and free from that strong odor 
which renders the use of brimstone so objectionable. That much of 
it when taken passes off by the skin in what is called insensible per- 
spiration, we know by the blackening of a silver watch or coins, 
which a person taking it may have about him. 

Sulphur acts upon the system as a laxative, and is commonly 
given as a purifier of the blood to children and scrofulous persons ; 
combined with cream of tartar, and other mild purgatives, it is a 
good medicine for piles ; as a deobstruent in affections of the liver, 
it is given in small doses with good effect ; it also acts as a diapho- 
retic and alterative, and is very useful in skin-diseases, especially 
itch. 

Sulphur, as an alterative, should be given in doses of from five 
to twenty grains three times a day ; as a purgative, from one to three 
drachms. Of either of the alkaline sulphurets the dose is from two 
to ten grains. The milk of sulphur is best given in milk, and acts 
all the better mixed with an equal weight of magnesia ; of this com- 
bination about a drachm is the maximum dose. The sulphuret of 
mercury with sulphur, prepared by rubbing together equal quanti- 
ties of quicksilver and brimstone, was at one time a favorite medi- 
cine, much given as an anti-venereal, alterative, and anthelmintic, 
under the name of ^Ethiop's mineral ; it is a most disagreeable form 
of preparation, being perfectly black, and is now nearly superseded 
by more active and agreeable forms ; it is, however, useful, especially 
in scrofulous, glandular swellings; the dose is from five to thirty 
grains ; treacle is the best vehicle of administration. 

Sulphuret of carbon, or carburet of sulphur, as it is sometimes 

called, is a light, volatile fluid, very inflammable, and having a 

penetrating odor. It is a diffusible stimulant, diaphoretic, and em- 

menagogue, in doses of from two to five drops ; in large doses it is 

24 



360 MATERIA MEDIO A. 

a dangerous narcotic ; it has been chiefly given as a sudorific in 
rheumatism, and applied externally as an embrocation to rheumatic 
joints, and to the abdomen for the after-pains of labor ; when inhaled 
it is an anaesthetic. 

RHUBAKB. 

This is one of the most useful and commonly-used drugs, the 
chief supply of which is obtained from Turkey and Russia ; it is pro- 
duced abundantly on the elevated lands of Tartary, Thibet, and 
Bhotan, growing spontaneously wherever the seed is distributed in 
places favorable to its growth. Some Chinese rhubarb is imported 
into Europe, but this is of an inferior quality. Attempts have been 
made to cultivate the plant for medicinal purposes in this country, 
but with very little success. Indian rhubarb, which is a native of 
the Himalayas, has been most successfully cultivated for culinary 
purposes, and its varieties now furnish an abundant supply of fruit 
for pies, puddings, and preserves. 

The primary action of rhubarb is that of a mild purgative, but it 
has also tonic and astringent properties, so that its secondary effect 
is to confine the bowels ; hence it is well fitted for use in diarrhoea, 
but not in constipation, or any a-ffection in which a continuous 
aperient action is necessary; it is not fitted for inflammatory or 
febrile cases, although it seldom acts as an irritant ; its stimulating, 
combined with its aperient properties, render it valuable in atonic 
dyspepsia. Generally speaking, it suits children and aged persons 
best. Where the bowels are sluggish, combined with ginger and a 
little soap, it makes an excellent dinner-pill. The ordinary dose 
of the powder is from twenty to thirty grains. Some persons have 
no objection to chew the root, and to such as have not, this is a very 
good way of taking it. The following are the principal officinal 
preparations into which rhubarb enters : 

Compound Rhubarb Pill. — Dose, ten to twenty grains. 

Extract of Rhubarb. — Dose, ten to thirty grains. 

Infusion of Rhubarb. — Made by macerating three drachms of 
ttie sliced root in a pint of boiling water for two hours. "Will not 
keep. Dose, a wineglassful. 

Tincture of Rhubarb. — One of the best cordial stomachics known. 
Dose, one drachm to one ounce. 

Syrup of Rhubarb. — Excellent for young children. Dose, one 
to two drachms. 

There are also an immense variety of medical compounds, of 
which rhubarb forms an important ingredient. Mixed with gray 
powder, it is an excellent remedy for the irritation of the bowels, 



MAGNESIA. 361 

common with children when teething. As a common aperient for 
the young, it is best given combined with magnesia. With both 
children and adults it has the property of communicating a deep 
tinge to the urine ; this should be known, as the change of color 
in the secretion of the kidney may occasion alarm and mis- 
conception. 

Garden rhubarb, when used as food, has a slight aperient action 
upon the bowels. In some cases this may be beneficial, but not in 
all ; those who have a tendency to relaxed bowels should not take 
it. Generally speaking, it is a wholesome and cooling article of 
diet ; but, if too freely taken, will be likely to cause urinary irrita- 
tion ; it contains oxalic and mallic acid abundantly ; hence its pleas- 
ant acidulous flavor. 

Rhein was the name given by M. Vaudin to a substance pro- 
cured by heating powdered rhubarb with nitric acid, evaporating 
to the consistency of syrup, and diluting with water ; it has been 
employed in Europe, but never much in this country. Rheinic 
acid is the acid contained in the stem of the garden rhubarb ; it ap- 
pears to be identical with oxalic acid. The purgative principle of 
the medicinal rhubarb has been called rhubarbarin. 



MAGNESIA. 

This is administered in three forms, viz., carbonate of magnesia 
(Magnesice carbonas), which is the commonest kind; calcined mag- 
nesia (M. usti), which is the pujest sort, and requires to be kept in 
stoppered bottles ; and sulphate of magnesia (31. sulphas), which is 
Epsom salts (for its uses and doses, see Epsom Salts). 

Both the pure magnesia and the carbonate are antacid, and act 
as mild laxatives on the bowels; but if given too often or too 
largely, as purgatives, they are apt to accumulate in the intestines 
in insoluble masses. We give magnesia as an antacid in dyspepsia, 
heartburn, pyrosis, gouty and lithic disorders. It is a very safe 
laxative for children, especially when combined with rhubarb ; in 
this combination it is administered in diarrhcea, and as a common 
purgative. The dose of magnesia is from three to five grains for 
children ; from ten to thirty grains for adults, according to the re- 
quired action. In habitual constipation, a combination of magnesia, 
rhubarb, and ginger, is found serviceable : this is commonly called 
Gregory's powder. A mild effervescent draught, which is slightly 
aperient, may be made by mixing one drachm of carbonate of mag- 
nesia with two tablespoonfuls of water, and then adding one table- 
spoonful of fresh lemon-juice, or one-half a drachm of citric acid ; it 



362 MATERIA MEDIC A. 

may be rendered more agreeable by the addition of a little grated 
nutmeg and powdered lump-sugar. The calcined magnesia is al- 
ways to be preferred ; but especially so when there is much wind in 
the bowels, or when they are in an irritable state. For heartburn, 
about half a drachm of magnesia, with twenty drops of sal-vola- 
tile, should be taken just before a meal; about fifteen or twenty 
drops of compound-tincture of lavender may be added. A clear so- 
lution, called Dinneford's fluid magnesia, has long enjoyed a high 
reputation ; it is a mild and not unpleasant aperient, and may be 
taken safely by both children and adults, especially if a little syrup 
of ginger be added to it. Magnesia, it should be remembered, only 
acts as an aperient when there is acid in the stomach ; therefore for 
this purpose it is best taken after fruit of some kind. 

Magnesia-water is made by mixing four ounces of carbonate of 
magnesia with one gallon of water, and impregnating it with ten 
times its volume of carbonic-acid gas, by means of a forcing-pump 
or soda-water apparatus. It makes a clear solution, is a good ant- 
acid, and an excellent vehicle for antacid and lithontriptic medicines. 



JALAP. 

This is one of the commonest and most valuable purgatives, but 
it is used far too indiscriminately ; for in irritable conditions of the 
bowels, or in weak states of the system generally, it is productive 
of mischief, on account of its active and drastic nature ; it produces 
watery evacuations, and often nauseates and gripes. The resin is 
sometimes extracted and given alone, but more commonly in com- 
bination with the woody fibre ; the ground root being the general 
form of administration : the dose is from two to five grains for chil- 
dren ; from ten to thirty grains for adults. It is sometimes given 
as a vermifuge, especially if combined with a little calomel. This 
drug derives its name from Jalapa, in Mexico, whence it is chiefly 
imported. The chief officinal preparations into the composition of 
which it enters are — the extract, dose from five grains to one scru- 
ple ; pill jalap with colocynth, five to ten grains ; compound powder, 
in which it is combined with cream of tartar and ginger, one scruple 
to one drachm ; -tincture, one to three drachms ; resin, three to 
twelve grains; mixture, one to one and a half ounces. The most 
efficient for ordinary use is the compound powder. Jalapine, which 
is the alkaloid, or active principle of jalap, may be sometimes given 
with advantage under careful superintendence ; but it is too power- 
ful for domestic use ; the dose is about one-eighth of a grain ; the 
smallness of the quantity required renders it a good mode of ad- 



ALOES.— CASTOR-OIL. 363 

ministering this nauseous drug, but it should never be intrusted to 
ignorant hands. 

ALOES. 

This is a resinous substance of an extremely bitter and aromatic 
taste. • A full dose operates slowly, though certainly, as a stimulant 
cathartic, acting chiefly on the lower bowels ; in small doses it is 
stomachic and tonic. Aloes is ranked among the Emmenagogues, 
and is useful as a remedy for the sluggish bowels to which persons 
of sedentary habits are particularly liable ; a five-grain pill, every 
other night at bedtime, will generally be found sufficient. In dys- 
pepsia, hypochondriasis, and jaundice, aloes may be given with 
advantage; it has a stimulating action on the rectum, and also 
on the uterus, therefore must not be prescribed when there is a ten- 
dency to piles, nor during pregnancy; on account of its extreme 
bitterness, pills are the best form of administration ; if a liquid form 
is adopted, it should be combined with liquorice and bitter tonics, 
which increase the purgative powers. There are three kinds of 
aloes commonly kept by druggists, viz., Socotrine or Cape, Barbadoes, 
and hepatic ; the former is the best for medicinal purposes, the two 
latter being too drastic in their operations ; they are more generally 
used by the veterinary surgeon. The following are the chief phar- 
maceutical formulas into the composition of which aloes enters : ex- 
tract of aloes, dose, one to five grains ; compound decoction of aloes, 
one-half to two ounces, a mild cathartic, and antacid ; enema of 
aloes, employed in dislodging worms from' the rectum ; compound 
powder of aloes, dose, ten to twenty grains, as a cathartic and su- 
dorific, having in it a portion of gum guaiacum and cinnamon-pow- 
der ; there is also a powder of aloes with canella, formerly much 
used as an aperient, under the name of hiera picra ; it is not found 
in the late Pharmacopoeias. There is, also, a tincture of aloes, sim- 
ple and compound, the dose of the former being from half a drachm 
to half an ounce, and of the latter, from one to two drachms ; and 
wine of aloes, given as a stomachic and purgative : in the former 
case from one to two drachms, and in the latter from one to two 
ounces. 

CASTOK-OIL. 

This well-known purgative is expressed from the seeds of the 
Ricinus communis, or JPalma Christi, a plant of the natural order 
Euphorbiacece, found in the East and West Indies. This oil is the 
mildest, safest, and most certain cathartic known, seldom griping, 



364: MATERIA MEDIC A. 

or causing flatulency ; it may, therefore, be administered in irritable 
conditions of the system to persons suffering from debility, and 
young children; after childbirth, in operations for lithotomy, in 
peritonitis, dysentery, and where there is inflammatory disease of 
the urinary organs. With most purgatives, the immediate effect is 
followed by a constipating tendency ; it is not so with castor-oil, the 
dose of which, after repetition, may be generally decreased; the 
usual quantity required is, for children, one to two drachms ; for 
adults one to one and a half ounces ; the best vehicles for its exhibi- 
tion are tea, coffee, gruel, barley-water, spirits-and-water, or pepper- 
mint, or some other aromatic water ; those to whom its oily flavor 
is especially nauseous will do well to chew a piece of fresh orange 
or lemon peel just previously to taking it ; this renders less acute 
the nerves of taste. It is sometimes made into an emulsion as fol- 
lows : put into a clean mortar the yolk of an egg, add to this six 
drachms of castor-oil, and well mix by trituration ; then add gradu- 
ally, to the extent of six ounces, cinnamon, or some other aromatic 
water. The mixture has the appearance of rich cream or custard ; 
the dose is about an ounce, that is, two tablespoonfuls. Exceptional 
cases sometimes occur of stomachs that will not retain the oil, dis- 
guise it how you may ; and on some it acts like a drastic purgative, 
causing intolerable pain or a deadly faintness during its operation ; 
such persons should avoid taking it. 

The term cold-drawn castor-oil, which commonly appears on the 
druggists' labels, refers to the mode of expressing it from the seeds 
between cold, instead of hot plates, as it was formerly prepared ; 
drawn in this way, the oil is clearer, purer, and less likely to be- 
come rancid by keeping. If good, it is without smell and almost 
colorless ; although thick, so that it flows from the bottle slowly, yet 
it is lighter than any watery vehicle, on which it will float in a body, 
and so go easily down the throat at a gulp ; when it has become of 
a light-brown or dark-yellow color, and has a hot, nauseous taste, 
it is rancid, or badly prepared, and is unfit to take. 



GAMBOGE. 

This well-known yellow gum-resin is the produce of an uncertain 
species of garcinia found in the East Indies. It is powerfully drastic, 
cathartic, and hydragogue, very irritating to the stomach, and likely 
to cause vomiting ;' hence its frequent employment for the expulsion 
of the tape-worm. Of most remedies for this parasite, gamboge 
forms an ingredient. It is not often given alone as a purgative, on 
account of its tendency to produce vomiting and griping ; but, in 



COLOCYNTH.— WILD CUCUMBER. 365 

combination with other cathartics, it operates more favorably ; com- 
bined with bitartrate of potash, it is useful in dropsical affections ; 
in solution with alkalies, it acts as a diuretic. The dose of the 
powdered gum, as a full purgative, is from two to six grains ; as an 
alterative, from half a grain up to six grains; of the compound 
gamboge-pill, and that of gamboge and scammony, the dose is from 
one to three five-grain pills ; of the alkaline tincture, we give from 
thirty to sixty minims ; and of Swediaur's, or the ammoniated tinc- 
ture, one drachm ; this latter should be given with great caution. 
For the expulsion of worms, the following is a good formula : 

Gamboge, .10 grains. 

Sulphate of iron, .......... 6 grains. 

Lump-sugar, 20 grains. 

Oil of pepperment, 3 drops. 

Water, 3 ounces. 

One ounce to be taken every four hours, until the desired effect is pro- 
duced. 

COLOCYNTH. 

This is a drastic purgative ; it was used by the ancients in drop- 
sical and lethargic diseases, but is now principally given in habitual 
constipation, in affections of the brain, as a revulsive, and in various 
diseases where an active purgative is required. In small doses it is 
expectorant, diuretic, and alterative; in overdoses poisonous, pro- 
ducing excessive irritation of the mucous membranes ; the dose of 
the powder is from two to eight grains ; in this form it is seldom 
given ; of the pill, or extract, from five to ten or fifteen grains ; it 
should never be given without some aromatic, to correct its griping 
tendency, and, to effect this object, is sometimes triturated with 
gummy farinaceous substances. A watery decoction, or infusion, 
has been recommended as less drastic than any other form of ad- 
ministration, and as especially good for worms, but this is not often 
used. 

WILD-CUCUMBER {Elaterium). 

The expressed juice of the fruit of this plant deposits a fecula, 
which, when dried, has been known by the name of elaterium. It 
is a very powerful cathartic, and is supposed by some physicians to 
be the best hydragogue purgative we possess. It is frequently em- 
ployed in dropsies, when purgatives are admissible, and other 
milder remedies fail in evacuating the water ; and it appears that 
ancient as well as modern physicians administered it with much 
confidence and success. But it is often very violent in its action, 



366 MATERIA MEDIC A. 

and requires to be given with caution, more especially in elderly or 
debilitated subjects. Its dose is a quarter of a grain, made into a 
pill, and repeated every second or third hour, until it begins to 
operate, when no more should be given until the extent of its opera- 
tion is ascertained. It is frequently advisable to unite the elaterium 
with the same quantity of calomel. The patient must always be 
supported with strong beef-tea and bread, etc., during its operation. 
The strength is variable in different specimens of this medicine. 
Of a good specimen, prepared according to Clutterbuck's method, 
one-twelfth of a grain is a dose. 

CROTON-OIL. 

Except elaterium tl\is is the most powerful of known drastic pur- 
gatives : it acts very speedily, when it does act, but this is somewhat 
uncertain ; one of its most marked effects is to increase the flow of 
urine. In obstinate cases of constipation, dropsy, and in apoplexy and 
•paralysis, where it is desirable that a speedy irritant action on the in- 
testines should be produced, resort is generally had to this oil ; and 
in locked-jaw and mania it is of great advantage ; a few drops placed 
on the tongue will produce catharsis. Externally it is a strong 
counter-irritant, producing redness, soon followed by pustular erup- 
tions ; thus employed, it is very useful in inflammation of the chest. 

MANNA. 

The sweet concrete juice which now goes by this name is pro- 
duced by several plants, but chiefly the Ornus {pvFraxinus) Mcropoea, 
and 0. or F. rotundifolia. This juice exudes spontaneously, but is 
generally obtained by making incisions in the tree ; the best kind is 
called flake-manna (M. canulata). Manna has a. sweet and slightly 
bitter taste, and acts as a gentle laxative; its purging property 
being due to the presence of a peculiar unfermentable sugar called 
mannate. In disorders of weakly women, and the affections of chil- 
dren, both manna and mannate are useful; having no unpleasant 
taste, they may be conveniently mixed with the food ; the dose is, 
for children, one to two drachms ; for adults, one to two ounces. 

ROOHELLE SALTS. 

The tartrate of potash and soda, used medicinally as a mild ape- 
rient; it was first found in a native state in Rochelle, hence its 
name ; it has not the nauseous taste of the Epsom or Glauber salts, 



RESIN OF PODOPHYLLUM.— SCAMMONY.—SEIDLITZ. 357 

and is, therefore, useful in cases which require a saline aperient, and 
in which they cannot be taken ; it forms the active component of 
Seidlitz powders, and may be safely given to children with infusion 
of senna ; the dose is from one drachm to one ounce ; it is well suited 
for cases of calculus, jaundice, and puerperal fever. It is the most 
convenient alkali for use in rheumatism. 



RESIN OF PODOPHYLLUM. 

This is one of our best native cathartics. It is made from the 
root of the May-apple. In doses of ten to twenty grains it is an 
active purge like jalap, quite as certain, and little apt to gripe; 
combined with a saline, as cream of tartar, it is a good hydragogue. 
Its best use is in habitual constipation. In these cases, given daily 
in very small doses, half or a quarter grain, it stimulates the bowels 
just enough to cause an evacuation, as nearly as possible in the 
manner of nature. 

SCAMMONY. 

This is a concrete gum. It is a powerful drastic purgative, 
stronger than jalap, and less unpleasant to take ; it is useful as a 
hydragogue in dropsies, and is given as a vermifuge in combination 
with calomel, and in other cases which require an active purgative. 
In irritable states of the stomach, however, it is decidedly mis- 
chievous. It enters into the composition of several of the pharma- 
ceutical preparations, and is a favorite ingredient with vendors of 
nostrums. The dose of the powder for adults is from five to ten 
grains ; for children, from three to five grains. It should always be 
combined with an aromatic, to prevent griping. The best scam- 
mony is that from Aleppo, which contains twice as much of the 
active principle as that from Smyrna. The compound scammony- 
powder is a combination of this gum with jalap and ginger, one part 
of ginger to two parts each of jalap and scammony. 

SEIDLITZ. 

The name of a Bohemian spa, whose waters owe their aperient 
quality to the presence of sulphate of magnesia, of which one hun- 
dred grains are said to be contained in every pint of the water, which 
differs essentially from the cooling aperient drink taken in this coun- 
try under the name of Seidlitz-powders. These consist generally 
of two drachms of Rochelle salts, two scruples of carbonate of soda, 
dissolved first in about half a pint of w r ater; then add half a drachm 



368 MATERIA MEDIC A. 

of tartaric acid, and drink while effervescing. There is no saline 
aperient so pleasant to take as this. 



SELTZER-WATER. 

This is a purgative mineral water which owes its active prop- 
erties to the presence of four grains of subcarbonate of soda, two of 
subcarbonate of magnesia, and twenty of muriate of soda, in twenty 
ounces of water impregnated with carbonic-acid gas. It is useful in 
some forms of dyspepsia and gravel ; to those in good health but 
little good can result from the habitual use of it. 

CHARCOAL. 

This is a simple, certain cathartic,- and antiseptic, useful in all 
disordered states of the stomach and the intestinal secretions. In 
doses of a teaspoonful, or twice that quantity stirred in water, it 
corrects offensive breath and mildly moves the bowels. No medi- 
cine can be used with less harm. Combined with carbonate of soda 
in equal quantities, it is useful in nearly all gastro-hepatic affections. 
As an application to foul, ulcerated surfaces, it may be added freely 
to the common bread-and-milk poultice. 

IPECACUANHA. 

This is one of the most valuable of medicinal plants ; taken in 
small doses, it is expectorant and diaphoretic, having a specific 
action on the bronchial mucous membrane, so as to excite its secre- 
tion when too dry ; it relieves the system, and causes sweating. In 
full doses, of about twenty grains, it is the safest and easiest emetic 
known; it does not nauseate, and reduce the system so much as 
tartar-emetic, nor is it so rapid and irritating in its action as sul- 
phate of zinc, which, however, is to be preferred in cases of narcotic 
poisoning, as promptitude of action is there of the utmost conse- 
quence, and irritation of the system is rather beneficial than other- 
wise. For children and delicate persons, ipecacuanha should always 
be preferred, where it is necessary to excite nausea or vomiting ; its 
expectorant property renders it especially serviceable in catarrhal 
affections, in which it is frequently given in combination with 
squills ; in febrile affections, we often employ it as a diaphoretic, 
combined with opium, as in Dover's powder. In whooping- 
cough and asthma it is given to relieve spasmodic constriction, and 
clear the passages of phlegm by vomiting; and in dyspepsia and 
dysentery it is also found beneficial. Of the powdered root, the 



ANTIMONY. 369 

dose, as an expectorant, is one or two grains ; as a diaphoretic, two 
to four grains ; as an emetic, ten to twenty grains, according to the 
age and strength of the patient ; for the latter purpose, it should be 
given in plenty of warm water, and as much as possible of this 
should be drunk after it. 

Among the officinal formulas of this plant are the decoction, ex- 
tract, lozenges, each containing half a grain ; powders, simple and 
compound ; pills, combined with opium and squills, syrup, and wine ; 
the last is the most generally used ; it may be made for domestic pur- 
poses by digesting for seven days one ounce of the bruised root in a 
pint of sherry wine ; dose, as expectorant and diaphoretic, ten to 
thirty minims; as emetic, two to four drachms, or, for children, 
twenty minims to a drachm. By boiling down one ounce of this 
with the same quantity of water, and two ounces of sugar, a syrup 
may be made for infants, of which from half a drachm to a drachm 
will be sufficient to produce vomiting. 



ANTIMONY. 

Antimony is a metal commonly found associated with sulphur ; 
it forms the base of several medicinal preparations of great utility, 
although possessing dangerous properties. In old pharmacopoeias 
it appears under the various forms of crude antimony, which is the 
ore mixed with sulphur ; regulus, the pure metal ; argentine flowers, 
an oxide, the result of combustion of the metal ; glass, liver, and 
crocus of antimony, which are all oxy-sulphurets, the result of heat- 
ing and vitrification of the ore. There is also powder of algaroth, a 
protoxide, and kermes mineral, which is the golden sulphuret of an- 
timony, so called from its resemblance to an insect of that name, and 
its rich yellow color. 

The preparation of antimony now chiefly used in medicine is 
the potassio-tartrate, commonly called tartar-emetic; externally a 
counter-irritant, applied in the form of ointment ; internally a dia- 
phoretic, in doses from one-twelfth to one-sixteenth of a grain ; an 
expectorant, one-sixteenth of a grain ; a contra-stimulant and emetic, 
from one to three grains ; and also a most effective sedative in dis- 
eases of the brain inflammatory in character. This is the most cer- 
tain in its operation of all the preparations of antimony ; hence its 
frequent employment in febrile and other diseases, especially those 
of the lungs and bronchial passages. Its most common form of ad- 
ministration is antimonial wine, the dose of which for adults is from 
twenty to thirty minims. It is very useful in whooping and other 
coughs, to promote expectoration and relieve the chest and trachea 



370 MATERIA MEDIC A. 

of phlegm ; and in active inflammation of the lungs, etc. The effect 
of antimony upon the pulse is generally very marked and rapid, and 
the prostration of strength which follows its administration renders 
it a dangerous remedy in the hands of an unqualified person. It is 
much too indiscriminately given. If an emetic is required, ipecacu- 
anha-wine is as certain in its operation, and much safer. 

The caution cannot be too constantly impressed upon the public, 
that all preparations of antimony, except very carefully crystallized 
tartar-emetic, contain more or less arsenic, a metal originally com- 
bined with antimony in its native state, and pertinaciously associated 
with it through all its modifications. The tartarized antimony of 
the shops is not always " carefully crystallized," hence the danger 
of its too indiscriminate use. In that sudden and often fatal disease 
in children called croup, tartar-emetic is one of the most ready and 
effectual remedies. Should the attack be violent, one-eighth of a 
grain may be given every quarter of an hour. Preparatory to the 
passage of an instrument into the urethra, or other constricted part, 
or the reduction of a dislocation, it is often administered with good 
effect, causing a relaxation of the muscles, and rendering the opera- 
tion comparatively easy. 

One of the mildest and safest forms of administration of anti- 
mony is the antimonial powder, commonly sold as James's powder, 
a patent medicine, from which it differs but little in its mode of 
preparation ; dose, as an alterative, one to three grains ; as a dia- 
phoretic, three to eight grains ; in larger doses, an emetic and pur- 
gative. 

MUSTAKD. 

Mustard is an excellent stimulant and rubefacient, and has gen- 
erally a good effect when applied over the seat of internal inflam- 
mation, especially when the seat of such is the chest, belly, or throat. 
The best way to make a mustard poultice or sinapism is, to mix to- 
gether equal parts of the best flour of mustard and of wheat, add suf- 
ficient boiling water to make up a very stiff paste, which spread thickly 
on a piece of linen rag of the required size ; put a piece of thin 
muslin over it, and then apply it to the part affected ; allow it to re- 
main on about twenty minutes, or half an hour, if it can be borne, 
so that it reddens the skin without producing a blister ; then take it 
off, and sprinkle the part, should it heat and burn much, with flour, 
or dress with simple cerate. Mustard lotions and ointments are 
sometimes used for local friction in paralysis, and as applications 
for chilblains and other indolent swellings. In cases of paralysis, 
poisoning, or torpor, from any cause, a mustard foot-bath to rouse 



SQUILL.— ZINC. 371 

the system may be beneficially employed. Mustard is also a stimu- 
lant to excite the stomach, and an emetic. For a stimulant, the 
seeds may be given whole, and thus given they are somewhat laxa- 
tive. The dose of the flour of mustard, as a stimulant, is from one 
scruple to two drachms ; as an emetic, about half an ounce or more ; 
of the seeds, about a drachm may be given. 

Vinegar is sometimes added to a sinapism; but, if the mustard is 
good, this is not required. 

SQUILL. 

In small doses squill is expectorant, diaphoretic, and diuretic ; in 
large, emetic and purgative ; in very large doses, the acrid principle 
which it contains is likely to render it poisonous. As a diuretic, the 
squill is generally given in dropsies ; as an expectorant, in chronic 
bronchitis ; it is usually combined with other medicines, as ipecacu- 
anha, paregoric, etc. Its chief officinal preparations are the com- 
pound squill-pill, dose from five to fifteen grains ; vinegar and oxymel 
of squills, dose from one-half to one drachm ; tincture of squills, dose 
from ten to thirty minims. The dose of the powder, as an expecto- 
rant, is about one grain. 

ZIXC. 

The chief medicinal preparations of this metal are : 1. The 
acetate, which is rarely given internally, but is well adapted for 
astringent lotions and injections, being milder and less irritating 
than the sulphate; it is found to answer well in leucorrhcea and 
gonorrhoea, and also as a collyrium in ophthalmia ; strength, half a 
drachm to a pint of distilled water. Sulphate, or white vitriol, 
given as an astringent in fluxes and hemorrhoids ; as a tonic in gen- 
eral debility ; and as an antispasmodic in cholera, epilepsy, gastro- 
dynia, hysteria, and neuralgia. In large doses it acts quickly as an 
emetic, without producing much nausea and prostration, as most 
emetics do ; it is, therefore, well adapted for administration in cases 
of poisoning ; for this purpose it may be given in half-drachm doses, 
repeated every quarter of an hour, in warm water; the close, as a 
tonic and antispasmodic, is from two to ten grains ; in epilepsy the 
dose may be greatly increased, from the minimum quantity to as 
much as will be borne without vomiting. This is one of the best 
astringent applications known, and is constantly used in eye-waters, 
gargles for relaxed uvula, injections for gonorrhoea, etc. ; it makes a 
good injection for piles ; strength, one drachm to one pint of water. 
What is commonly called flowers of zinc is, in fact, the oxide which 
flies up when the metal is exposed to a temperature in the air a 



372 MATERIA MEDIC A. 

little above its melting-point, in the form of a fine white flocculent 
powder. Its action is mainly antispasmodic. Chloride, sometimes 
called butter of zinc, is one of the most powerful caustics known ; 
has been given in small doses, but is generally used for external appli- 
cation, to destroy the surface of a cancerous or phagedenous sore, 
or the eruption of lupus, being safer than arsenious acid ; for such a 
purpose, it is generally made into a paste, with flour, or combined 
with chloride of antimony. 



BLUE VITKIOL. 

Blue vitriol, or sulphate of copper, is powerfully emetic in the 
dose of five or six grains in water ; and astringent in the dose of a 
quarter of a grain, combined with extract of logwood. In doses of 
from two to twelve grains, dissolved in two ounces of water, it 
operates almost instantly as an emetic, and is, therefore, an eligible 
medicine to excite vomiting when laudanum has been swallowed as 
a poison. A solution of it in water is a very beneficial application 
to indolent and foul ulcers, which it stimulates and cleanses, and 
thus promotes their healing. In the dose of a quarter of a grain, or 
even half a grain, mixed with extract of logwood, it is efficacious in 
diarrhoea and dysentery. 

LOBELIA {Indian Tobacco). 

In small doses this promotes the secretions of the gastro-pul- 
monary tissues, and at the same time affects the nervous system as 
a narcotic. In larger doses it is an emetic, and its operation is at- 
tended with general relaxation. In still larger doses it produces 
excessive prostration and death. Its dangerous character has pre- 
vented its employment to a great degree, though it is a certain and 
in careful hands a most valuable remedy. It is almost a specific for 
spasmodic asthma. In powder the dose for an adult is from ten to 
twenty grains. Half an ounce of the tincture is an emetic dose. 
For an expectorant, give one or two drachms ; to a child, five to 
twenty drops. Every part of the plant has medicinal effect, but 
the parts most powerful are the leaves and capsules. 



balsam: OF PERU. 

This balsam is demulcent, stimulant, and tonic, and is used in 
chronic coughs, whites, palsy, and chronic rheumatism ; but it is im- 
proper wherever any iDflammatory action is present. As an external 



BALSAM OF TOLU.— SENEKA.— BENZOIN. 373 

application, it is employed with advantage in cleansing and stimu- 
lating foul and indolent ulcers. Tlie dose is from ten drops to a 
drachm, twice a day. 



BALSAM OF TOLU. 

This is obtained from the same tree as the preceding, and may 
be considered as the white balsam of Peru, hardened by exposure to 
the air. Its virtues and dose are similar to the Peruvian balsam, 
but it is less stimulating. 

The Tolu lozenges are made by mixing together eight ounces of 
fine sugar, one ounce of cream of tartar, two drachms of starch, and 
a drachm of the tincture of balsam of Tolu of the Edinburgh Dis- 
pensatory, which are brought to a proper consistence, and formed 
into lozenges, by means of a sufficient quantity of mucilage of gum- 
tragacanth. 

SENEKA. 

Seneka, or senega, is a stimulant to the mucous membranes and 
skin, and is expectorant, acting especially on the bronchial tubes — 
the air-passages ; and is therefore useful in chronic cough and hu- 
moral asthma. It is a very valuable remedy in some cases in the 
latter stages of bronchitis, in aged and debilitated constitutions ; 
and its efficacy is greatly increased in combination with sesquicar- 
bonate of ammonia. 

It is best given in decoction. Ten drachms of seneka-root are 
mixed with two pints of water, and boiled down to one pint, of 
which the dose is from two to four tablespoonfuls, three times a day. 

BENZOIN. 

Gum-benzoin is the balsamic resin of the Styrax benzoin. It is 
a good stimulant and expectorant ; and, when burned, its vapor is 
deodorant, and. antiseptic ; it is therefore useful in sick-rooms and 
hospitals. When sublimed by heat, it yields benzoic acid ; this, as 
well as the gum itself, is diuretic and useful in calculous disorders, 
especially where there are phosphatic deposits; its combinations 
with ammonia, potash, and soda, called benzoates of these alkalies, 
are more decidedly diuretic, and useful in dropsy and gouty concre- 
tions, etc. They may be readily prepared by adding benzoic acid 
to the alkalies. Benzoin mixed with ointment prevents rancidity ; 
its vapor is thought to be good in whooping-cough ; it is a common 
ingredient in cosmetic washes, and makes a good balsamic tincture 
for wounds and cuts. 



374 MATERIA MEDIC A. 



MYRRH. 



This gum-resin possesses tonic and' antispasmodic properties, and 
acts upon the mucous membrane as a balsamic, checking the secre- 
tions when excessive. It is given in atonic dyspepsia, in chlorosis, 
in amenorrhea, and in chronic bronchitis, often in conjunction with 
aloes and chalybeates. The tincture is used in gargles, and the 
powder-gum in dentifrices ; the latter is also sometimes applied to 
foul ulcers ; the dose of the powder is from ten to thirty grains ; the 
best form of exhibition is the pill form, in combination with aloes, 
rhubarb, galbanum, assafoetida, and sulphate of iron; its officinal 
preparations are the tincture of myrrh, compound iron mixture, and 
pill of aloes with myrrh ; the latter of which is a good laxative for 
dyspeptic patients. 

SANGUINARIA (Bloodroot). 

This is an effective expectorant, an emetic, an alterative, a tonic, 
and even a narcotic, differing in its effects according to the way in 
which it is used. In small and repeated doses it increases secretion 
in the whole mucous tract. Give of the powder five grains in pill 
every two hours, or at similar intervals twenty to thirty drops of 
the tincture. 

SERPENTARIA ( Virginia Snakeroot). 

Warmth and rest in bed, with a moderate heat in the room, are 
the best diaphoretics. Next come medicines. The root is the part 
used ; it is in the form of slender fibres, with knotted heads. It is 
an aromatic, tonic, and diaphoretic, in large doses causing nausea and 
relaxation of the bowels. It was at one time much given in agues 
and other intermittents, tfsually in combination with bark ; it is still 
sometimes administered, with stimulants and diaphoretics, in typhoid 
and other fevers of an exhaustive character. The dose of the pow- 
der is from ten to thirty grains ; of the infusion, from one to two 
ounces ; of the tincture, from one to three drachms. 



DOVER'S POWDER. 

This preparation of opium, ipecacuanha, and sulphate of potassa, 
is a very certain and admirable diaphoretic. It may be given to 
grown persons in doses of ten grains. In that quantity there is one 
grain of opium. 



SPIRITUS MINDERERL— NITRE. 375 

SPIRITUS MINDERERI. 

This is the liquor ammonise acetatis, and, in doses of a teaspoon- 
ful once in two hours, excites and keeps up a gentle action of the 
skin. It is an excellent article in nearly all cases of fever, and is 
sold by the apothecaries as " fever-drops." 



NITRE. 

Nitre is refrigerant and diuretic. Taken in repeated small doses 
of six or eight grains, it abates heat and thirst in fevers and inflam- 
mations, diminishes the force and frequency of the pulse, and in- 
creases the secretion of urine. It is, therefore, efficaciously given in 
rheumatic fever, and all inflammatory diseases, and generally forms 
a part in saline draughts. But it is improper in hectic fevers. In 
the foregoing diseases, it is best given in doses of six or eight grains, 
every three or four hours, dissolved in water, and in combination 
with the solution of acetate of ammonia and antimonial wine. In 
some kinds of dropsy, it may be given to the extent of a drachm 
every morning, dissolved in ale, and in this manner it has cured 
several cases. 

It frequently affords relief in the advanced stages of indigestion, 
and what are too often called liver-complaints. It is most useful in 
allaying the general increase of heat, and burning in the hands and 
feet which are so apt to come on in these disorders toward night ; 
but it likewise seems to add to the good effects of the other alter- 
ative means employed, whenever there is a considerable hardness in 
the pulse. It is not at all adapted to recent cases of indigestion, 
nor to those of some standing if there is no evident tightness in the 
pulse. The dose most extensively useful, in the former description 
of case, is five or six grains, which may be made into a draught with , 
twelve drops of tincture of henbane, half an ounce of Minder er us' s 
spirit, and an ounce of water, and taken thrice in the twenty-four 
hours. If the languor of the circulation be considerable, it will 
often be better to substitute a drachm of the tincture of orange-peel 
for the henbane. 

A small portion of it, allowed to dissolve slowly in the mouth, 
often removes incipient inflammatory sore-throat ; and it is a useful 
adjunct to gargles in that complaint. 

In very large quantities, which have sometimes been given by 
mistake for other salts, it excites vomiting, bloody stools, convul- 
sions, and even death. The best antidotes are opium and aromatics. 
Copious draughts of a decoction of linseed or barley, or sugar and 
25 



376 MATERIA MEDIC A. 

water, should be taken, and the poison extracted from the stomach 
by the stomach-pump. 



SWEET SPIRIT OF NITRE. 

This medicine is a pleasant refrigerant and diuretic, and is used 
with much advantage in all febrile affections, to allay heat and 
quench thirst, and in dropsy as an adjunct to other diuretic reme- 
dies. Its operation is greatly increased by dilution with water, or 
some other aqueous vehicle. In fevers, thirty or forty drops of it 
may be given every three hours, united with two drachms of the 
solution of acetate of ammonia, and an ounce and a half of. water. 
In dropsy, it may be administered to the extent of a drachm at a 
dose, combined with other and more powerful diuretics. 



JUNIPER. 

Juniper-berries yield a volatile essential oil, upon which the fla- 
vor and diuretic properties of the spirit called Ginevra, or gin, prin- 
cipally depend. The berries of the common juniper, when ripe, are 
of a purplish-black color ; they have a strong aromatic odor pecu- 
liar to themselves, and a flavor much like that of turpentine ; they 
are aromatic, stimulating, diuretic, and diaphoretic, and are chiefly 
employed as an adjuvant to other remedies, and to increase the flow 
of urine in cases of dropsy ; the dose of the berries themselves is 
from one to three drachms ; they may be taken in powder, but the 
oil of compound spirit is more frequently administered ; the dose of 
the former is from four to six minims ; of the latter from two to 
four drachms. An infusion of juniper-tops is sometimes taken ; it 
may be prepared thus : 

Fresh tops of the plant, .1 ounce. 

Boiling water, 1 pint. 

Infuse for two hours and strain ; take a wineglassful twice a day. 

It is best, however, used as a vehicle for other diuretics. 

In some parts of Europe, juniper-berries are roasted, ground/and 
used as a substitute for coffee ; they are also employed, in Sweden 
and Germany, as a conserve, and as a culinary spice, especially to 
give a flavor to that favorite dish of the Germans, sauer-kraut. The 
gum-sandarac, which exudes from one of the species of juniper, con- 
stituted, when powdered and sifted, the substance called pounce ; 
and the oil of juniper mixed with nut-oil makes an excellent varnish 
foi pictures. 



DIGITALIS.— BUCHU. 377 

DIGITALIS {Foxglove). 

In its medical qualities this is sedative and diuretic. It has a 
great influence over the action of the heart, and of the extreme ves- 
sels of the circulating system, and is, therefore, often very bene- 
ficially employed in palpitation, dropsy, aneurism, and delirium 
tremens. It diminishes the frequency of the pulse, and the general 
irritability of the system. In palpitation of the heart, accompanied 
with great nervous irritability, it may be combined with camphor- 
mixture and tincture of columba, and is often very useful. 

It may be given in substance, in watery infusion, or in tincture. 
When given in substance it is always proper to begin with a dose 
not exceeding a grain of the powdered leaves, made into a pill, twice 
a day, it being gradually increased till its effects are apparent either 
on the kidneys, the stomach, the pulse, or the bowels ; the medicine 
then must be discontinued. But in dropsy it may be repeated after 
an interval, if the whole of the water be not evacuated. The infu- 
sion is made by macerating for four hours a drachm of the dried 
leaves in half a pint of boiling water, to which is then added half an 
ounce of spirit of cinnamon. The dose is from two to six drachms 
given twice or thrice a day. The tincture contains all the virtues 
of the plant, and may be given in doses of ten or fifteen drops thrice 
a day. If foxglove occasions vomiting or purging, it almost cer- 
tainly fails as a diuretic, and should, therefore, in such cases, be 
united with a small quantity of opium or opiate confection. In 
dropsy its efficacy is increased by being combined with calomel ; 
and an occasional dose of sweet spirit of nitre is useful in counter- 
acting nausea and flatulence. During its employment, under any 
form, diluting drinks are useful and necessary ; and, immediately it 
is discontinued, the strength should be recruited by generous food, 
steel, and cordial tonics. 

The deleterious effects of an overdose are best counteracted by 
laudanum in brandy-and-water, and by the application of a blister 
to the pit of the stomach. 

It is a dangerous medicine. The unpractised are very apt to be 
deceived in the dose, as the first or second may appear to be with- 
out effect, and when the third is given all three take hold at once 
with accumulated power. Thus, there may be a poisonous dose in 
the system at once. 

BUCHU. 

Buchu is aromatic, stimulant, and actively diuretic. Taken 
internally it gives tone to the digestive organs, promoting the 



378 MATERIA MEDIC A. 

appetite, and correcting nausea and flatulency. It has been almost 
exclusively used in diseases of the urinary organs. In chronic in- 
flammation of the bladder it frequently proves beneficial, allaying 
irritation and checking excessive secretion. It has also been used 
with good effect in rheumatism. The dose of the powdered leaves 
is twenty or thirty grains two or three times a day ; of the infusion 
one to two ounces, and of the tincture one to four drachms. 

. COPAIBA. 

This is a balsam or resinous juice. It is strongly diuretic, and 
stimulates the mucous membranes generally ; in large doses laxative, 
and is commonly given in diseases of the urinary organs, especially 
gonorrhoea ; it is also useful in chronic affections of the chest. It 
may be applied externally, with advantage, to chilblains and indolent 
ulcers. The dose is from ten to sixty minims, in plain or aromatic 
water, bitter infusion, or tincture, or any convenient vehicle; to 
some the taste is extremely nauseous, and may best be got rid of by 
chewing some orange-peel after it. An emulsion of copaiba is some- 
times made by mixing the balsam with mucilage, yolk of egg, or 
liquor of potash ; it should be strongly flavored with oil of cinnamon. 
There is also an oil of copaiba, dose fifteen to twenty minims. 
Syrup, two to eight drachms, and resin ten to thirty grains. Co- 
paiba-capsules are formed by enclosing the balsam in little vesicles 
of gum-acacia; in this manner it may be taken without the objec- 
tionable flavor being noticed ; the capsules may be bought of any 
druggist, with directions for use. 

CUBEBS. 

Cubebs is a species of Java pepper. It is diuretic, and slightly 
purgative, and certainly possesses considerable effect in allaying 
irritation in the urethra and mucous membrane of the bowels. It 
has been much and successfully used of late in the cure of gonor- 
rhoea ; but it will be found of great service in many cases of weak- 
ness, relaxatio», or deficient action in the larger bowels, in which it 
acts as a mild stimulant and corroborant, that improves the secre- 
tion of the parts, and gives a cool sensation to the rectum, in pass- 
ing the faeces. It is useful in whites, and in the chronic affections 
of other mucous membranes, as in chronic disorder of the bladder, 
etc. 

The best mode of taking it is in powder, in doses of from a 
scruple to a drachm and a half, four times a day, in water. It is 
frequently adulterated. 



CANTHARIDES.— UVA URSI.—PAREIRA BRAVA. 379 

CANTHARIDES. 

The blistering or Spanish fly. Not only is this insect of the 
beetle-tribe much used as a blistering agent, but it is also given in- 
ternally, acting chiefly as a stimulant of the urinary organs ; it has 
been found especially useful in obstinate gleet, paralysis of the 
bladder, and as a diuretic in atonic dropsy, as well as in some dis- 
eases of the skin. It should, however, be administered with great 
caution, as an overdose will very likely produce strangury, and set 
up inflammatory action which may lead to fatal results. The best 
remedies are clysters of starch and linseed-tea, with or without 
laudanum, milk, emulsions of acacia, and other demulcent drinks ; 
-bleeding if there is much fever, warm baths, and aperients and 
nauseating medicines. Camphor has been highly recommended in 
a case of this sort, but we question its efficacy ; calomel may be 
given with advantage in small and frequent doses. Besides the 
blistering preparations, such as ointments and plasters already 
spoken of, there is a cantharides-liniment and other compounds, used 
as stimulants and rubefacients. 

UVA UKSI. 

This is a trailing shrub found in all mountainous districts of the 
Northern Hemisphere, both of the Old and New World ; the leaves 
are used medicinally as an astringent, tonic, and diuretic; their 
more particular action appears to be on the urinary organs ; they 
are especially rich in tannic acid, containing about thirty-six per 
cent. ; they are chiefly given in chronic inflammation of the bladder, 
and have to be continued for a considerable time. This medicine is 
sometimes prescribed in combination with hyoscyamus, in which 
combination it is found serviceable in cases of irritation from the 
presence of stones in the bladder. The dose of the powdered leaves 
is from one scruple to one drachm every three or four hours ; of the 
extract from five to ten grains, as a tonic ; of the decoction from one 
to two ounces. This is made by boiling one ounce of the leaves in 
one and a half pints of water till it is reduced to a pint. 

PAREIRA* BRAVA. 

This is a perennial plant, growing in the West India islands and 
in South America. The root, which is the part employed, is brought 
from Brazil ; it is long, thick, and covered with a furrowed brown 
bark. It has little or no smell ; the taste is bitterish, blended with 
a sweetness like that of liquorice. 



380 MATERIA MEDIC A. 

It has been for many years in high repute among the Brazilians 
as a remedy in all obstructions of the urinary organs. The common 
people of Jamaica use a decoction of it for pains and weakness of 
the stomach proceeding from relaxation, and it is probable that its 
effects in urinary disorders are due chiefly to its tonic influence on 
the bladder. One of the most prominent symptoms of chronic in- 
flammation of the bladder is an abundant discharge of a ropy adhe- 
sive alkaline mucus, and we have Sir B. Brodie's testimony to the 
fact that the use of the decoction of the root of the pareira brava 
is here frequently productive of excellent effects. 

The decoction is prepared by simmering four ounces of the root 
in three pints of water, until it is reduced to two pints, and then 
strained ; the dose of this decoction is a small teacupful (about four 
ounces) twice or thrice a day. A little tincture of henbane may 
sometimes be advantageously combined with it. 

DULCAMARA {Bittersweet). 

The woody nightshade, the dried twigs of which are used medi- 
cinally, being regarded as alterative, diuretic, sudorific, and mildly 
narcotic ; it is used in skin-diseases and catarrhal affections ; also in 
scrofula, chronic rheumatism, and syphilis ; the dose being, of the 
powder, from one to three scruples ; of the decoction, about a wine- 
glassful ; of the extract, from five to ten grains ; of the syrup, half an 
ounce to an ounce. This plant is nearly allied to the potato, which 
it very closely resembles in the odor of its root. It grows wild in 
roadside hedges, and especially affects those near ponds or streams 
of water ; its twining stems often reach to the height of five or six 
feet; its purple-and-yellow blossoms, and bright scarlet berries, 
closely resemble those of the deadly nightshade ; and children are 
said to have been poisoned by eating the berries ; as have grown 
persons from an overdose of the decoction of the fresh twigs, which, 
in the country, are still extensively used. There are, however, many 
safer and better remedies. For making the decoction, the twigs 
should be gathered whenever as thick as a goosequill ; one ounce of 
them, chopped up, to be boiled in a pint and a half of water, until 
reduced to half the quantity. 

EUPATORIUM (Boneset). 

This is a tonic sudorific. In moderate doses in powder, or cold 
infusion, it is tonic ; but, in larger doses and warm infusion, its action 
on the skin is energetic. Its popular name of boneset is derived 
from its efficiency in what is called in some parts of the country the 



IRON. 381 

breakbone fever. ' Dose of the powder twenty to thirty grains. 
Make the infusion with an ounce to a pint of boiling water, and take 
a small cupful three or four times a day. 



IRON. 

This metal is used medicinally in a variety of forms, the chief 
value of which consists in their tonic properties, rendering them 
very useful in debilitated states of the system. Weak, pallid, and 
delicate persons may generally take these preparations with safety 
and advantage ; but those who are habitually costive, who suffer 
from piles, or from a determination of blood to the head, should 
carefully avoid them, their usual effect being to increase the arterial 
action, and promote the secretions : therefore, to an excited state of 
the circulation they are unsuitable. As a rule, no person with a 
naturally florid complexion, or a full habit of body, should take iron, 
which is most commonly prescribed for chlorotic anaemia, scrofula, 
enlargements of the liver and spleen, fluor albus, gleet, passive 
haemorrhages, chorea, atonic dyspepsia, chronic dysentery and 
diarrhoea, tic-douloureux and other nervous affections, and worms. 
The administration of iron should generally be preceded by that of 
purgatives, and, if headache or constipation follow its use, it should 
be discontinued. 

The preparations of this metal are so numerous, and some of 
them so little used and unsuitable for domestic employment, that 
we need only particularize a few of them — such as are most avail- 
able for this purpose. We may observe at the outset that they are 
all oxides and salts, and that they are often spoken of as chalyb- 
eates. 

Ammonia-citrate of iron is an elegant and agreeable prepara- 
tion, applicable especially to uterine diseases, and also to general 
debility. It may be given in cinnamon or other aromatic waters, 
but not in bitter infusions, as it turns most of them black ; the dose 
of this is from five to eight grains. It is kept in combination with 
quinine, and may be beneficially exhibited when a bitter tonic is 
required. 

Carbonate, or sesquioxide of iron, is a red, insoluble powder, 
disagreeable to take, on account of its bulk ; as much as a drachm 
or two drachms of it being required, three or four times a day. It 
should be made into an electuary with confection, honey, or treacle. 
It is a good chalybeate tonic, and has a high reputation for the cure 
of neuralgic affections, especially tic-douloureux ; it must be taken for 
a considerable time to do much good. A very pleasant preparation 



382 MATERIA MEDIC A. 

of this excellent medicine is made by Gamier & L'Amoreux, of 
Paris, in sugar-coated pills of three grains each, of the formula 
known as Valet's mass. 

Iodide of iron is an excellent tonic in scrofulous debility and 
deficient menstruation, strumous swellings, incipient cancer, dis- 
eased mesenteric glands, and scrofula generally. The dose is from 
two to five grains, but it is difficult to keep either in a solid form or 
solution, as it very soon decomposes. It may be obtained in the 
form of syrup, and may be kept good in a well-stopped bottle for a 
considerable time, especially if a piece of iron wire is kept in it ; the 
dose of this is from fifteen minims to a drachm. 

Muriated tincture of iron is a good astringent and tonic, and 
acts specifically upon the urinary organs ; it is therefore useful in 
irritation of the bladder and retention of urine, depending on spas- 
modic stricture of the urethra : in vomiting and spitting of blood it 
is also serviceable. The dose is about ten minims, and for stricture 
it may be given every ten or fifteen minutes, to the extent of six or 
eight doses, but it should not be carried beyond this. This is also 
an excellent local styptic, and may be applied with advantage to 
loose fungous sores, and as an astringent to relaxations of the throat, 
with a camel's-hair brush. 

Sulphate of iron, sometimes called green vitriol, but more com- 
monly copperas, is poisonous in large doses ; but in small doses, that 
is, from one to five grains, is a good emmenagogue, and also anthel- 
mintic : its astringent properties render it useful in profuse haemor- 
rhages, chronic diarrhoea, and dysentery. It enters into the compo- 
sition of the compound steel-pill, and the compound steel-mixture of 
the pharmacopoeia, being combined in both cases with myrrh and an 
alkali : when properly and freshly made, in which case it will be of 
a decided green color, the latter is one of the best emmenagogues 
that can be administered. The dose is about two tablespoonfuls 
two or three times a day. 

The tartrate, or potassio-tartrate, of iron, has similar properties 
with the ammonia-tartrate, and may be applied to the same purposes. 
One objection to the continued taking of most preparations of iron, 
and especially the muriated tincture, and the sulphate, is that it is 
likely to discolor the teeth : while taking it, persons should be care- 
ful to keep them well cleaned, and to use an alkaline tooth-powder. 



BISMUTH. 

The subnitrate, or oxide of bismuth, is a tonic and antispasmodic 
medicine of uncommon efficacy in many cases of indigestion, where 



MANGANESE. 333 

pain in the stomach is a prominent symptom. It is also of peculiar 
efficacy in that disorder when accompanied with frequent rejection 
of water from the stomach ; and in spasmodic affections, such as 
epilepsy, palpitation of the heart, and spasm of the limbs. The dose 
of bismuth is from two to six or ten grains, twice or thrice a day. 

It is a valuable remedy ; is soluble in the gastric juice ; its action 
is rapid; it produces no sensation of weight at the stomach; it 
rarely constipates, and may be employed for a long time without 
oppressing the stomach. All cases of gastralgia, or chronic inflam- 
mation of the digestive organs, cases in which the tongue is red and 
pointed, and cases in which the digestion is laborious and accompa- 
nied with putrid or acid eructations, or in which there is a tendency 
to diarrhoea, or spasmodic vomiting, are benefited by the employ- 
ment of bismuth. It is also valuable in the vomiting of children, 
whether caused by dentition, or succeeding frequent fits of indiges- 
tion, and in the diarrhoea of weak children, especially when occurring 
at the time of weaning. 



MANGANESE. 

This is a metal, resembling iron in some respects ; but it is so 
alkaline that it speedily oxidizes in air. It is found mostly as the 
gray oxide ; but the black oxide is common also, either as a sul- 
phate, a phosphate, or a silicate. The black peroxide is the form 
most generally used by chemists, and sometimes by medical practi- 
tioners. For scabies and syphilis, it is given internally, in doses of 
from three to twenty grains : in the former disease, and in some 
cutaneous maladies, it is also applied in the form of ointment. The 
salts of this metal are believed by some to be equal to those of iron, 
for their tonic properties ; hence the acetate, the carbonate, and the 
sulphate, are used medicinally : the first as an alterative, in doses 
of five to ten grains ; the second, for the same diseases, and in the 
same doses as the binoxide ; and the last as an alterative simply, in 
doses of five to ten grains ; as a purge and cholagogue, dose from 
one to two drachms. There are preparations of manganese with the 
sulphates and carbonates of iron, in which the properties of the two 
metals are combined. The chloride, iodide, malate, and tartrate of 
manganese are also sometimes given, in the form of pills, in scrofula, 
anaemia, and various skin-diseases. 

A combination of the black oxide, salt, and sulphuric acid, makes 
a good mixture for the evolution of chlorine, as a disinfectant. 



38.4: MATERIA MEDIC A. 



CINCHONA. 



This is the Peruvian bark. It is obtained from several species 
of plants belonging to the natural order Cinchonacece, found chiefly 
in South America. There seems to be some doubt as to which of 
these particular species yields the barks of commerce and medicine. 
Linnaeus confounded at least four of them under the trivial name C. 
officinalis, and botanists are now by no means agreed as to specific 
identity. 

The medicinal barks are distinguished as pale-yellow and red. 
The red is more astringent and nauseous, and the yellow more 
bitter. Being powerfully tonic and antiseptic, bark was first intro- 
duced into medical practice for the cure of intermittent fevers ; but 
it has since been largely employed in general and nervous debility, 
fever (if of the typhoid kind), and gangrene. It has also been 
recommended for gout and acute rheumatism ; during its exhibition 
in such cases, great attention should be paid to the state of the 
bowels, purgatives being occasionally interposed. 

The great objection to the use of powdered bark is the quantity 
required to be taken, the dose ranging from ten grains to two 
drachms, two or three times a day : milk is a good vehicle for it. 
Of the infusion or decoction, from one to four ounces is the dose. 
Where it is desirable to combine cordials, the powder may be taken 
in port-wine, or an infusion of the bark may be made by pouring a 
pint of this wine, previously heated, over one ounce of the bruised 
bark, and taking a wineglassful two or three times a day. 

Besides the decoction, infusion, and powder, the following are 
forms of administering bark : Extract, and resinous extract, dose, 
ten to thirty grains ; simple, compound, and ammoniated tinctures, 
dose, of either, one to four drachms. There are also a syrup and a 
wine of bark ; and, for outward use, a cerate, an ointment, an ana- 
septic cataplasm, and a powder of bark with myrrh; indeed, the 
combinations into which this useful ingredient enters are almost 
infinite. 

Bark is subject to extensive adulteration; the better are not only 
mixed with the inferior kinds, but frequently with those from which 
the active ingredients have been extracted by decoction or infusion. 
The quill being that which fetches the highest price, the bark-gath- 
erers sometimes call in the aid of artificial heat to give it that form, 
but by this process the quality is deteriorated ; it may generally be 
known when this fraud has been perpetrated, by the darker color of 
the bark, and by its exhibiting, when split, stripes of a pallid hue in 
the middle. When bark is of a dusky color, between a yellow and 



QUININE. 385 

a red, it is either a bad species, or has been badly preserved. If 
perfectly good, it will be dense, heavy, and dry, with no smell of 
must, but a slight and very peculiar odor ; the taste bitter, with a 
slight acidity, neither nauseous nor very astringent : if chewed, the 
fibres should not be of great length, nor stringy. But it is in the 
form of powder that bark is most likely to be adulterated ; all sorts 
of woody fibres are ground up and mixed with it, and the requisite 
color is given with red and yellow ochre. Such adulterations it is 
almost impossible to detect. 

Since the introduction of the alkaloids quinia and cinchona, in 
which the active principles of bark reside, the bark itself has fallen 
into comparative disuse, although some of the officinal preparations 
are yet frequently ordered by medical practitioners. 



QUININE. 

Quinine is extracted from the Peruvian bark by a chemical pro- 
cess, and, being afterward combined with sulphuric acid, forms the 
crystallized disulphate of quinia, or quinine, as it is commonly called. 
For internal administration this has almost entirely superseded the 
more bulky and disagreeable preparations of the bark itself, than 
which it is more active and efficacious. Except, perhaps, opium, 
there is no drug more valuable to the medical profession than this. 
As a tonic and anti-periodic, it stands unrivalled; in agues, and 
intermittent fevers of all kinds, it is now indispensable ; in neuralgic 
affections, and those arising from debility, its good effect is generally 
marked and decided. It has lately been recommended in cases of 
typhoid fever, and in the sinking stage, combined with port-wine, is 
certainly beneficial. The common dose of the disulphate of quinia 
is one or two grains three times a day ; it is best given in solution, 
combined with double the quantity of dilute sulphuric acid, without 
which, or some other acid, it is insoluble in water ; it is often given 
in some bitter infusions, such as gentian, or calumba ; sometimes in 
infusion of roses, the acid of which readily dissolves it. 

Many elegant and useful combinations of this substance have 
recently been introduced, such as the valerianate of quinine, highly 
recommended as a nervine and antispasmodic ; the arsenite of qui- 
nine, which combines the antispasmodic action of the arsenious acid 
with that of the quinia ; and the citrate of iron and quinine, most 
serviceable in debility and facial neuralgia. 

Quinidina, or quinidine, is an alkaloid found in some kinds of 
barks ; it much resembles the true quinine, both in its appearance 
and action, although it is, perhaps, somewhat weaker. There is also 



386 MATERIA MEDICA. 

a brown kind, called amorphous quinine, which is the quinidine in 
an impure state ; it does not dissolve so readily as the white crystals, 
nor act so efficiently ; the dark, thick solution which it makes with 
acid is apt to cause nausea, and other unpleasant symptoms. 



SIMARUBA. 

Simaruba-bark possesses much the same properties as quassia, 
with which it has a close botanical as well as medical affinity. Like 
most other bitters, it causes vomiting and purging when given in 
large doses ; it is useful in all cases where a simple tonic is required ; 
it is not given in substance, but in the form of an infusion, the dose 
of which is from one to two ounces. This drug is much used in 
Germany in the latter stages of dysentery and diarrhoea. 



GENTIAN. 

The dried root of Gentiana lutea is one of the most deservedly 
valued of the bitter vegetable tonics ; it is especially useful in states 
of exhaustion from chronic disease, and all cases of debility of the sys- 
tem, unconnected with excessive irritability of the stomach. It has 
also febrifuge, anthelmintic, and antiseptic properties, and as a warm 
stomachic tonic stands perhaps unrivalled. The forms in which it is 
exhibited are the powdered root, dose from ten to twenty grains (this 
is sometimes sprinkled on foul sloughing ulcers) ; the extract, five to 
twenty grains ; the infusion, made by macerating two drachms of 
the root, sliced or bruised, with a little dried orange-peel, in a pint 
of boiling water for a couple of hours or so ; dose, one to two ounces ; 
mixture, the same dose : compound tincture, one to two drachms : 
wine, about three drachms. It is of this root that the publicans 
make their " bitters," either by steeping it in brandy or other spirits, 
or by employing the tincture to impart the needful bitterness to the 
spirits. By far the best preparation, however, is the infusion, which 
may be made to keep any length of time in the following manner : 
Take four ounces of sliced gentian-root, and one ounce of dried 
orange-peel, and pour upon them a quart of boiling water, let it 
stand about three hours, strain off the liquid, and pour in another 
quart of water, repeating this process three or four times, until the 
strength of the ingredients is exhausted ; then put the whole of the 
strained infusions together in a saucepan, well lined or porcelained 
inside, and boil down to a single quart ; to this add two ounces of 
alcohol, which will coagulate the mucilaginous constituents of the 



QUASSIA.— WILLOW-BARK.— NUX-VOMICA. 387 

infusion, which may be separated by straining, so as to leave it per- 
fectly clear ; bottle and cork it tightly : when required for use, add 
one teaspoonful to an ounce of water for a dose. 



QUASSIA. 

Quassia is purely tonic, invigorating the digestive organs with 
little excitement of the circulation, or increase of animal heat ; it has 
an intensely bitter taste, but no perceptible odor. Its virtue de- 
pends upon a bitter crystallizable principle, which has been called 
quassin ; when heated it melts like resin ; both alkalies and acids in- 
crease its solubility in water. A strong decoction of quassia is a 
good poison for flies, which would seem to be a proof that it has 
narcotic properties ; it is said that brewers sometimes used the 
wood as a substitute for hops. The infusion of the quassia of the 
pharmacopoeia is made by pouring a pint of boiling water on two 
scruples of the chips or raspings ; it is given as a tonic and antiseptic, 
in bilious fevers, united with alkaline salts ; in gout, with aromatics 
and ginger ; in hysteria, with camphor and tincture of valerian ; in 
dyspepsia, with sulphate of zinc or iron, or with mineral acids ; the 
dose is from one ounce to four ounces. 



WILLOW-BARK. 

The bark of the common willow is tonic and alterative, and is 
useful in ague, indigestion, and some chronic eruptions on the skin. 
In fact, it may be efficaciously employed in all the complaints for 
which Peruvian bark, or quinine, is ordinarily administered. The 
dose of the powder is from half a drachm to a drachm, twice a day, 
in water. The decoction is an eligible mode of taking it, made by 
simmering together for half an hour one ounce of the bark in a pint 
of water, of which the dose is from two to four tablespoonfuls twice 
a day. 

Salicine is the crystalline active principle obtained from willow- 
bark, and is a mild, bitter tonic, similar to quinine. Should quinine 
irritate the stomach, probably salicine would not do so. The dose 
is from ten to twenty grains, in a wineglassful of infusion of orange- 
peel, twice a day. 

NUX-VOMldA. 

The strychnos nux-vomica is a native plant of the East Indies, 
where it is commonly called the poison-tree. In India and Arabia 
it has been used as a medicinal plant from time immemorial, and 



388 MATERIA MEDIC A. 

more recently in Europe as an antidote to the plague, and as a 
remedy in intermittents, dyspepsia, dysentery, diarrhoea proceeding 
from debility, worms, hysteria, rheumatism, and hydrophobia : 
when taken in large doses it produces fearful consequences. The 
symptoms of poisoning by this substance are, first, agitation and 
trembling; these are succeeded by stiffness and twitching of the 
limbs, which gradually becomes more violent until a fit of spasm 
succeeds, in which the head is bent back, the spine stiffened, the 
legs extended and rigid, and the respiration checked for a time : 
then follows an interval of comparative ease and composure, during 
which the senses are entire and unusually acute ; but this is soon 
broken by another spasm more violent than the last, and so on until 
the patient dies of suffocation, produced by the spasmodic constric- 
tion of the muscles of the chest. The poisonous effect of this drug 
appears to be owing to its exciting action upon the spinal system 
of nerves. There is no known antidote for the poison, and death is 
generally the result of taking it, but some success has followed the 
use of aconite as a remedy in such cases. Tobacco has been recoup 
mended, and said to have proved efficacious in some cases. ISTux- 
vomica contains two alkaline principles — strychnia or strychnine^ 
and bruchia or bruchine ; they are united with a peculiar acid 
called igasuric or strychnic acid. The pharmaceutical preparations 
of nux-vomica are the extract, dose one-half a grain, and the tinc- 
ture, five to ten minims. Since the introduction of strychnine, 
however, these have been less used, and no preparation of 
this most powerful drug should be used except with the greatest 
caution. 

The bark of the nux-vomica, called false angustura-bark, is 
sometimes used as a tonic and febrifuge ; and the root, which is 
very bitter, is used by the natives of India to cure intermittent 
fevers and the bites of venomous reptiles ; the fruit in which the 
seeds are enclosed is soft and pulpy ; it is, when ripe, of a beautiful 
orange color, and is greedily eaten by birds ; the seeds are used in 
the preparation of spirits, to render them more intoxicating; they 
may have been occasionally employed for this purpose by unscru- 
pulous brewers, but not, as we imagine, to any great extent. 



STKYCHNINE. 

Strychnine, the alkaline principle of nux-vomica, is a powerful 
stimulant to the spinal cord, and is, in large doses, a virulent poison. 
It is scarcely adapted to domestic use. Notwithstanding, it has 
been employed medicinally with good effects, especially in water- 



CITRATE OF QUININE AND IRON— SAGE. 389 

brash, costiveness, and paralysis of the throat and lower limbs, or 
of one side. "I often join with iron," says a distinguished practi- 
tioner, " small doses (from one-twentieth to one-fourteenth of a 
grain) of strychnine. If the pulse intermits, this remedy sometimes 
exhibits its tonic powers over muscular fibre by restoring regularity 
of beat, and thus gives you the satisfaction of feeling the good you 
do with it." Strychnine has great power in imparting tone and in- 
vigoration to the involuntary muscles of the stomach, and relieves 
the sense of oppression found in indigestion, especially where bark, 
iron, or other tonics, in any way disagree. 

One grain of pure strychnia may be dissolved in one ounce of 
distilled vinegar, of which solution ten drops may be given in half 
a wineglassful of water, thrice a day, the dose being cautiously in- 
creased to twelve or twenty drops. Should the remedy display its 
influence on the system by exciting involuntary tetanic movements 
or convulsions of the limbs, then the medicine must be either dis- 
continued, or much lessened in the dose. 



CITRATE OF QUININE AND IRON. 

This salt is now employed very extensively as a general tonic, 
and is found efficacious in all cases where quinine and its salts, and 
especially in combination with iron, are applicable. It will be found 
invariably to agree with the stomach. The energy of the respec- 
tive bases, quinine and iron, is greatly increased by their union in 
this compound, and this salt seems to exercise a specific action upon 
the economy. It is admirably adapted to most cases of debility, to 
ague, and neuralgic pains ; and generally, where a combination of 
iron and quinine is required, this is the most efficient preparation. 
Dose, two to five grains. The syrup of citrate of quinine and iron 
is the most agreeable form in which it can be prescribed for 
children. The dose of the syrup is from half a drachm to a drachm, 
in plain or spiced water. 

SAGE. 

The common garden sage {Salvia officinalis) is a plant possessed 
of tonic properties, as its aromatic odor and bitter taste indicate ; 
an infusion made of its leaves and flowering tops is often taken un- 
der the name of sage-tea, and is tonic and astringent ; as a gargle, 
with vinegar, or honey and alum, it is beneficial in inflammation of 
the throat, or relaxed uvula. The volatile oil, with which the plant 
abounds, is sometimes prescribed in doses of one or two drops, and 
is also used as an ingredient in embrocations for rheumatism ; prep- 



390 MATERIA MEDIC A. 

arations of the plant are used to abate the sweating in hectic 
fever : the dose of the powdered leaves is from twenty to thirty 
grains. 

Another species of sage, called S. sclarea, commonly called 
clary, has a pleasant odor, much like that of balsam of tolu, and is 
used for seasoning soups, etc. ; it has antispasmodic and cordial 
properties. 

CHAMOMILE-FLOWERS 

Are tonic and carminative, and are useful in indigestion, gout, 
green-sickness, flatulent colic, and chronic weakness of the stomach 
and bowels. In such cases they are best given in the form of a cold 
infusion, or tea, in combination with ginger and carbonate of soda. 
The warm, strong infusion is emetic. The extract of chamomile- 
flowers is an excellent stomachic, possessing little stimulus, and fa- 
voring the natural action of the bowels, and is, therefore, a conven- 
ient and useful addition to other tonics which we wish to give in 
the form of pills, as preparations of iron, ipecacuanha, carbonate of 
soda, etc. 

The dose of the powder is from half a drachm to a drachm, twice 
or thrice a day ; of the infusion, from one to two ounces ; and of the 
extract, from ten grains to a scruple. 



WORMWOOD. 

Wormwood is a bitter tonic, of considerable service in indiges- 
tion ; and it has also been used with advantage in ague and gout. Its 
powers in expelling worms are well ascertained, and have bestowed 
upon it the name of wormwood. It will frequently bring away the 
smaller sorts of worms in great quantities. The dose in powder is 
from one to two scruples, twice or thrice a day. The infusion is 
made by pouring a pint of boiling water on an ounce of the plant, 
of which from an ounce to an ounce and a half may be taken twice 
or thrice in twenty-four hours. 

CALUMBA, OR CALUMBO. 

The root so called, which is much valued as a stomachic bitter, is 
that of the Coculus palmatus, a native of the forests on the east coasts 
of Africa ; it has a faintly aromatic odor, a bitter and slightly acrid 
taste ; its active principle is columbine, which may be obtained by 
means of alcohol or ether. Containing nothing which is incompati- 
ble with the salts of iron, its infusion forms a good vehicle for them ; 



MERCURY. 391 

it is prepared by pouring upon five drachms of the sliced root a 
pint of boiling rain or distilled water, macerate for two hours in 
a covered vessel, and strain. There is also a tincture, of which a 
dose may be taken, in water, twice a day. The dose of the 
former is from one to two drachms ; of the latter, from five to ten 
grains. 

Calumba appears to actf chiefly upon the mucous membrane of 
the stomach, and upon the secretion and quality of the bile ; being 
free from astringency, slightly sedative, there is, perhaps, no tonic 
so well adapted for those of weak and dyspeptic constitutions : to 
such it may be given in powder, combined with carbonate of 
soda and ginger, in the proportion of eight drachms of each of the 
former to two drachms of the latter ; taking half a teaspoonful in a 
wineglassful of water about an hour before or after each principal 
meal ; or it may, perhaps, be more agreeable to add the soda to an 
infusion of the calumba-root and ginger; this infusion should be 
made fresh every day, especially in warm weather. [See Tonics.) 

MERCURY (Hydrargyrum). 

The compounds of this metal are alterative, anthelmintic, anti- 
phlogistic, antisyphilitic, cathartic, and deobstruent. They are all 
of them, except, perhaps, the sulphurets, capable of inducing a state 
of mercurialism, of which the prominent symptom is salivation ; 
therefore, their action should be carefully watched. Some of the 
preparations are corrosive poisons, and all of them may do serious 
mischief if incautiously used. 

Preparations of quicksilver directly promote the secretion of the 
bile, or its flow into the intestines ; they also increase the effect of 
diaphoretics and diuretics. We give a list of the principal mercurial 
compounds, their uses and doses : * 

Hydrargyrum JBichloridum (Corrosive Sublimate). — One of 
the strongest poisons known ; given in venereal complaints with the 
greatest advantage, when a quick and general action is required, 
but its effects are often not permanent ; and in chronic rheumatism. 
A solution of three grains in a pint of water makes a good gargle 
in venereal sore-throats, or a little stronger for breaking the abscess 
in cynanche tonsillaris ; this strength also may be used as a wash 
for scabies, for tetters, and for destroying fungi. Given internally, 
the dose is from one-sixth to one-half grain, made into a pill with 

* The chemical names of corrosive sublimate and calomel are given according to 
the old theory of their composition. Recent chemistry calls corrosive sublimate the 
chloride and calomel a subchloride. 

26 I 



392 MATERIA MEDIC A. 

extract of poppies. When taken in poisonous doses, the best anti- 
dote is white of egg. 

Hydrargyrum Chloridum (Calomel). — In venereal diseases and 
liver-complaints, sometimes combined with opium ; in scrofula, with 
cicuta ; in convulsive affections, with opium, camphor, and assa- 
fcetida, etc. ; in dropsy, with squills, foxglove, and elaterium ; in 
rheumatism, with antimonials, guaiacum, and other sudorifics ; 
as a purgative, in any case not attended with intestinal inflamma- 
tion, generally with some other purgative; combined with lime- 
water, makes black wash. 

Pil. Hydrargyri. — This is the blue-pill, a most effective alterative 
in a wide range of disorders to which the system and the digestive 
organs are subject. It may be given in doses of five to ten, or even 
twenty grains, followed by a purgative, or in smaller doses contin- 
uously to obtain the mercurial effect on the system. 

Hydrargyrum lodidum, in strumous affections ; dose one grain, 
gradually increased to three, or four, used externally in oint- 
ment. 

Hydrargyrum Oxidum Rubrum (Red Precipitate). — Seldom, 
if ever, given internally ; used in the preparation of ointments, and 
applied in this form, or in that of powder, to chancres and foul 
ulcers, to cleanse and stimulate them; sometimes blown into the 
eye, in the proportion of half a grain to four grains of sugar, to re- 
move specks on the cornea. 

Hydrargyrum cum Greta (Quicksilver and Chalk, or Gray 
Powder). — Chiefly given as an alterative in cutaneous and bilious 
affections ; dose, five to thirty grains. 

These are but a few of the principal forms in which quicksilver 
is administered and applied ; there are many others, for there is, 
perhaps, no single agent in the materia medica whose uses are more 
numerous and various ; it not only has a specific action, but it ap- 
pears to quicken and intensify that of any other drug with which it 
is combined ; thus it is that we find it so often in combination with 
diaphoretics, with diuretics, with purgatives, etc. ; perhaps its most 
remarkable and valuable property is its power of controlling and 
subduing inflammations of whatsoever part, and its action in this 
respect is especially marked and rapid in those affecting the eye. 
But it is on the liver that its most decidedly specific action is ex- 
erted ; in small doses it stimulates the 41ow and improves the char- 
acter of the bile ; in larger it causes the bile to flow yet more freely, 
and carries it through the bowels with a purgative action. Fre- 
quently, when the liver is in an overloaded condition, a very small 
dose of some mercurial preparation, such as calomel, will cause a 



IODINE. 393 

very rapid descent of the fluid. When it is intended that mercury 
shall act upon the system generally, its tendency to purge must be 
checked by combination with opium, or it will be likely to pass off 
too rapidly, without producing the desired effect. When intended 
to affect the liver, Abernethy recommends that it shall be given by 
itself at night ; a five-grain blue pill is best, or the same quantity of 
gray-powder, and a black draught, castor-oil, or some other liquid 
purgative, in the morning. 

On certain constitutions mercury exerts a peculiar influence, 
causing in some great irritation, in others deadly faintness and 
nausea. Children can bear larger doses than adults ; indeed, it is 
often difficult to salivate a child. The stools caused by mercurials 
are generally of dark olive-green color ; particularly is this the case 
with the young. 

IODINE. 

This is a crystallized solid substance, found principally in sea- 
water, and in plants and other marine productions; it becomes 
volatile at a slight increase of temperature, and diffuses itself in 
the form of a beautiful violet vapor, hence the above name. This 
is one of the most valuable of therapeutic agents, and is largely 
employed in its various forms and combinations. We now chiefly 
obtain this substance from the ashes of the kelp, or sea-weed, which 
is burnt for the purpose of obtaining alkali ; the ashes are heated 
with sulphuric acid and peroxide of manganese, and the vapor 
which arises is received in a cold vessel, where it condenses on the 
sides, and forms the soft, opaque crystals, of a blackish-blue color, 
and metallic lustre, which constitute the iodine of commerce. It 
has a disagreeable, suffocating odor, and nauseous taste, and it 
stains whatever it touches, of a rusty yellow color, which remains 
on the skin for a considerable period. It dissolves readily in alco- 
hol, but very little in water ; its characteristic property is that of 
giving an intense blue color to starch, of the presence of which 
it is, therefore, a sure test. United with metals it forms iodides^ 
and with hydrogen and oxygen, acids, like bromine and chlorine ; 
in many of its properties it bears a close resemblance to the 
latter. 

Iodine, although only obtained in a pure state of late years, has 
long been employed as the efficient principle of several therapeutic 
agents, such as burnt sponge, and certain mineral waters. Its spe- 
cific action has been only ascertained, with precision, since it has 
been procured as a distinct principle. Owing to its sparing solubil- 
ity in water, it is seldom now, however, administered in a pure state, 



394: MATERIA MEDIC A. 

but rather in the form of some artificial compound, such as the 
iodide of potassium, its most common vehicle of administration. 
The diseases in which it has been found most useful are glandular 
swellings, especially bronchocele or goitre, which rarely resists its 
continuous action. In chronic rheumatism, and some forms of stru- 
mous disease, it is also efficacious. It has been given, too, in cases 
of poisoning with brucia, strychnia, and veratria — not, however, 
with such decided success as to warrant our calling it a certain 
antidote to these formidable poisons. As an outward application, 
iodine has been of late most extensively employed. In bronchitis 
and chronic enlargements of the abdominal viscera, especially of the 
liver, it has proved eminently successful; in the latter case it is ad- 
vantageously combined with mercury. It may be applied in the 
form of tincture, painted over with a camel's-hair brush, to enlarged 
tonsils, and to chronic swellings of the joints, as well as to glandular 
swellings. It is an excellent emmenagogue, combined with iron, 
and with mercury is valuable in syphilitic diseases. As a means of 
dispersing organic exudations, lotions of iodine are much to be 
preferred to ointments ; they should be applied on compresses of 
lint, saturated with them, and bound over the parts. The following 
may be recommended as a good form for this purpose : 

Take of iodine, . . . . . . . 10 grains. 

Iodide of potassium, 1 drachm. 

Distilled water, 1 pint. 

For painting over a glandular or other swelling, the compound 
tincture of the pharmacopoeia may be used ; if not strong enough, 
add iodide of potassium, half a drachm ; iodine, ten grains to one 
ounce of the tincture. It has been found that this substance will 
dissolve more readily in water to which syrup of orange has been 
added, than in plain water, and more readily still in that which has 
tannin in it. Two grains of this latter will, it is said, effect the 
solution of ten grains of iodine in six ounces of water, a quantity 
sufficient for most therapeutic purposes ; the dose being from one to 
two grains ; so that about a tablespoonful of this mixture might be 
taken two or three times a day. The action of iodine and its com- 
pounds should be carefully watched, as a long train of alarming symp- 
toms will sometimes follow its continued use ; among these may be 
named vertigo, nausea, extreme depression, and syncope, sometimes 
ending in death. Its chief officinal preparations, besides its metallic 
compounds with potassium, iron, lead, mercury, and arsenic, etc., 
are the compound liquor of potash with iodine ; dose, one to four 
drachms ; syrup of iron with iodine, dose, half a drachm to one 



COD-LIVER OIL. 395 

drachm, an excellent tonic for scrofulous children ; compound tinc- 
ture of iodine, dose, ten to thirty minims ; compound iodine-oint- 
ment ; and the ointment of iodide of potassium. 



COD-LIYER OIL. 

This oil is prepared from the liver of the cod-fish, and some other 
allied species ; it has of late years come into very extensive use as a 
therapeutic agent ; it was formerly of good repute in the treatment 
of rheumatism, but, being extremely nauseous, never obtained gen- 
eral acceptance; this objection is, in a great measure, obviated by 
the present improved methods of preparation, and the best cod-liver 
oil, being almost colorless, and free from taste or smell, except a 
slight fishy impregnation, may be taken by the most delicate 
stomach. Consumptive patients, apparently on the brink of the 
grave, have experienced quite a renovation under its influence ; the 
sunken cheeks have again become plump and tinged with the hues 
of health ; the dim eyes have shone with their former brightness, 
and the dark rim around them has disappeared; the emaciated 
frame has gathered flesh, and the weak, vacillating step has grown 
firm and steady as of old. Such, we say, has been the effect in some 
cases ; in very many, if not so marked, it has proved decidedly 
beneficial ; so that the dictum of Dr. Williams — " we must pause ere 
we in future pass the terrible sentence of ' no hope ' on the consump- 
tive patient " — is in no want of confirmation. There is some differ- 
ence of opinion as to whether iodine, bromine, or phosphorus, all of 
which are contained in cod-liver oil, is the peculiar principle which 
renders its operation so beneficial in arresting the progress of tuber- 
cular destruction of the lungs, in giving firmness to the muscles, and 
filling up the decayed tissues with adipose matter ; but probably all 
three have a share in the effect produced. In all diseases connected 
with a scrofulous habit of the constitution, this oil has been used 
with great advantage ; in general debility, its decidedly nutritive 
properties render it extremely valuable ; and in atrophy, or wasting 
of the flesh in children, where the glands of the belly are knotted 
and hard, and the veins enlarged, it often effects a cure ; in such a 
case it is given internally, about a teaspoonful twice a day, and also 
rubbed into the skin of the stomach three times a day. In rickets 
it is the most efficient of all remedies. , 

The common dose of cod-liver oil for an adult is one tablespoon- 
ful, two or three times a day ; sometimes double this quantity is 
given, but it is always advisable to begin with a small dose, and 
gradually increase. With regard to the best vehicle for its admin- 



396 MATERIA MEDIC A. 

istration, this must depend greatly upon individual taste ; but milk, 
orange- wine, ale, or some bitter infusion, cinnamon, or other aromatic 
water, and cold coffee, may be mentioned as among the best ; for 
children it may be made into an emulsion with yolk of egg and 
sugar, or disguised in well-sweetened cocoa, in which state it is 
sometimes taken unknowingly; raspberry-vinegar is not a bad 
vehicle. About an hour before a meal is the best time for taking 
this oil ; it is then less likely to cause nausea, and more likely to 
become assimilated with the food. Patients who have become 
accustomed to it experience a sensation of sinking and faintness 
when the usual dose is omitted, which fully bears out its character 
as a nutrient ; with some it acts slightly as a laxative, and with 
others causes a difficulty of breathing, and a feeling of fulness in the 
chest and head, and even spitting of blood ; but these effects are 
quite exceptional. 

Medical men are by no means agreed as to whether the pale 
or the dark oil is the best; the former appears to contain the 
largest quantity of iodine, bromine, phosphorus, and salts of lime, 
soda, and magnesia ; and the latter to be richest in the component 
parts of bile, butyric and acetic acids : the pale is less likely to 
cause nausea, if it is really fresh and pure, so that it is more gen- 
erally preferred; although that which is of a light orange-color 
may be highly recommended, as containing a large proportion of 
the peculiar principles which render this oil so valuable, and espe- 
cially of iodine. 



SARSAPAMLLA. 

This drug is tonic and alterative in its properties ; sometimes 
diuretic and diaphoretic; it is chiefly given in secondary syphilis, 
in various kinds of skin-diseases, in phthisical and scrofulous dis- 
orders, and in cachectical and depraved conditions of the system, 
especially such as depend on old venereal disorders ; the form of 
administration is usually that of the compound decoction, or the 
liquid extract, which contains a portion of spirit, and will keep al- 
most any length of time ; the dose of this is from half a drachm to 
two drachms in water ; of the decoction from three to six ounces ; 
the powder is sometimes given in half a drachm to two drachm 
doses, but it is generally stale and inert. The simple decoction, 
which is perhaps as efficacious as any preparation of this drug, is 
made thus : Digest five ounces of sarsaparilla-chips in four pints of 
water ; let it simmer gently for two hours ; then take out the chips, 
bruise and replace them in the water; boil down to two pints, and 



GUAIACUM. 397 

strain. The compound decoction is made by adding to the above 
quantity, while boiling, sassafras (sliced), guaiacum-wood (rasped), 
and liquorice-root (bruised), of each ten drachms, mezereon-roots 
three drachms ; boil for fifteen minutes, and strain. These prepara- 
tions can be made for domestic use, but it is perhaps best to pur- 
chase the liquid extract. The virtues of the sarsaparilla appear to 
reside in a crystalline principle which has been called sarsaparillin 
or similicine / besides this principle the root contains a coloring sub- 
stance, resin, a thick aromatic fixed oil, a waxy substance, chloride 
of potassium, and nitrate of potash, with starch, of which the pro- 
portion is large. 

GUAIACUM. 

The Wood and gum-resin of the lignum vitce, a West-Indian 
tree, are both used medicinally for the cure of chronic, cutaneous, 
and syphilitic diseases, gout, and rheumatism. The wood, which is 
very hard and close-grained, is rasped small, and from it is prepared 
the decoction of guaiacum ; dose from two to four ounces ; it is also 
one of the ingredients of the compound decoction of sarsaparilla, 
and other diet drinks taken to purify the blood, and enters into the 
composition of the compound lime-water: an extract is likewise 
made from it, of which the dose is from ten to thirty grains. The 
gum is given in powder in ten or twenty grain doses, often mixed 
with magnesia or milk of sulphur : its other officinal preparations 
are mixture of guaiacum, dose from one to three tablespoonfuls, two 
or three times a day, and simple and compound or ammoniated 
tinctures, dose from one to two drachms. Those suffering" from 
chronic gout and rheumatism, especially if of syphilitic origin, can- 
not do better than take guiaicum-mixture and Plummer's pill — 
the former prepared thus : 

Powdered gums, guaiacum and acacia, of each, . l£ drachm. 

Nitrate of potash, ..:.... £ drachm. 

Tincture of conium, or hyoscyamus, .... 1 drachm. 

Or tincture of opium, £ drachm. 

Cinnamon-water, ....... 6 ounces. 

Mix and take two tablespoonfuls three times a day, with one of the 
above-named pills every night. 

If more agreeable to take it in the form of powder, rub down 
three drachms of each of the gums with one drachm of nitrate of 
potash, and nine drachms of compound cinnamon-powder; take 
half a drachm in a little milk three times a day. The nostrum 
called the Chelsea pensioner is composed of guaiacum, one drachm ; 



398 MATERIA MEDIO A. 

rhubarb in powder, two drachms ; cream of tartar, an ounce ; flow- 
ers of sulphur, two ounces; one nutmeg finely powdered; which 
are to be made into an electuary with one pound of clarified honey. 
Two large spoonfuls to be taken night and morning. 

Guaiacum is also one of the medicines rated as emmenagogues, 
whose certainty of action is the most to be relied upon. 



ARSENIC. 

This is the metallic base of several salts and oxides and prepara- 
tions therefrom, used medicinally, all of which are highly poisonous, 
and should therefore be very cautiously employed or administered. 
The common white arsenic of commerce is properly arsenious acid 
(Aeidum, arseniosum). In this form arsenic is not often prescribed; 
the solution with potash, as in Fowler's solution {Liquor potassce 
ar senilis), being preferred : it is chiefly given in obstinate chronic 
diseases of the skin, and in intermittent fevers, and other peri- 
odic diseases : the doses varying from five to fifteen minims : it 
has been said that for the first-named class of disease it is never re- 
quired in larger doses than five minims, given three times a day on 
a full stomach, the dose to be reduced as soon as the system be- 
comes unduly affected by it ; which may be known by itching and 
redness of the eyelids, swelling of the cheeks and eyes, soreness of 
the mouth, and a feeling of giddiness ; or it may be that there are 
griping pains in the stomach, nausea, if not vomiting, and headache ; 
in the latter case it should be discontinued altogether, as it is evi- 
dently an unsuitable remedy for the individual. It should never be 
used internally for persons of plethoric habit, or who have any 
symptoms of phthisis ; but to such it may be applied in the form of 
ointment, so that it may act by absorption : one part of the white 
oxide rubbed down with seven parts of spermaceti-ointment is a 
good formula. 

The symptoms of poisoning by arsenic are as follows : First 
come on faintness and nausea, with a burning pain in the stomach, 
which continues to increase ; then follow diarrhoea, cramps in the 
calves of the legs, incessant vomiting, the matter discharged being 
brown and turbid, containing mucus and sometimes blood; the 
retching is violent, there is great heat in the throat, and intense 
thirst ; the pulse becomes faint and irregular, the skin, if not ex- 
tremely hot, cold and clammy, the respiration labored and painful, 
until death ensues, preceded sometimes by coma, or by paralysis, 
tetanus, convulsions, and spasms of the extremities. 

Remedies, to be of any use, must be given immediately, mustard 



TARAXACUM. 399 

and water, or other emetics, the stomach-pump, milk, lime-water, 
and white of egg, as much as can be got down ; but little confi- 
dence, however, can be placed in antidotes ; the poison is of so cor- 
rosive a nature, that, if suffered to remain in the stomach, it will be 
pretty sure to do irreparable mischief ; therefore all the efforts 
should be directed to getting it out as soon as possible ; excite 
vomiting by all possible means, and throw in diluents. If the 
treatment should be successful, and the patient appears to be 
recovering, administer hydrated sesquioxide of iron, if it can be 
procured ; give a spoonful largely diluted with water, every hour 
or so. 

TARAXACUM (Dandelion). 

A common plant of the fields in this country, it possesses tonic, 
alterative, diaphoretic, and diuretic properties, and has long enjoyed 
the reputation of being beneficial in obstructions of the liver, and in 
visceral diseases ; its action appears to be somewhat like that of 
sarsaparilla, and it is often given in dyspepsia, dropsy, skin-disease, 
and cachectic disorders generally. Being easily procured, and of 
well-established repute, it is one of the plants most frequently used 
by country people for the cure of their ailments : a decoction is 
made of the fresh root sliced, about an ounce of which is put into a 
pint of water; this is boiled down to half a pint, and strained; add 
to this quantity two drachms of cream of tartar, and take a wine- 
glassful twice or thrice a day. The most convenient form is the 
extract, which is prepared by first obtaining the juice from the fresh 
root by pressure, and then evaporating until it is somewhat thicker 
than treacle ; the dose of this is from ten grains to half a drachm ; 
it is frequently given in combination with stronger diuretics, in dis- 
ease of the urinary organs. The following is a good form of com- 
bination for chronic affection of the liver : 

Extract of taraxacum, 2 drachms. 

Carbonate of soda, 1 drachm. 

Spirit of sulphuric ether, 2 drachms. 

Syrup of orange-peel, •£■ ounce. 

Infusion of gentian sufficient to make up 8 ounces. 
A tablespoonful to be taken twice a day with two and a half-grain blue- 
pill, or a five-grain Plummer's pill every night for the first week, then 
every other night. 

In Germany, the poorer people roast the dandelion-roots, and 
take the decoction of these for coffee, and this article has recently 
come into use in the United States. The leaves also are very com- 



400 MATERIA MEDICA. 

monly used on the Continent as a salad ; they are no doubt very 
wholesome thus taken, and, to some constitutions, beneficial; by 
these leaves the plant may be easily distinguished, when not in 
flower, from their deeply-indented shape, from whence they obtain 
the name " lion's tooth " {dent de leori). 



ALCOHOL. 

Pure alcohol is a transparent, colorless fluid, of a pungent taste 
and fragrant odor ; it is lighter and more volatile than water, burns 
with a blue flame, which becomes yellowish when the spirit is diluted 
with water, when mixed with an equal bulk of which, it is termed 
proof spirit; it then has a specific gravity of 0.917, and this is not 
quite so strong as that used for many tinctures and other phar- 
maceutical purposes, the strength of which is represented by 0.930, 
the gravity of pure alcohol being, according to Lo witz, 0. 796, although 
the Ley den College make it 0.815. The pure spirit of commerce is 
seldom less than from 0.830 to 0.835. 

Alcohol is the active principle of all intoxicating drinks, the 
habitual use of which, according to Dr. Paris, induces " more than 
half of all our chronic diseases." Brandy, rum, gin, whiskey, etc., 
are but variously-flavored forms of diluted alcohol ; medicinally 
they are sometimes prescribed, and employed with good effect; 
brandy has been found especially useful to rouse the system in some 
cases of extreme debility, and in sinking stages of typhus fever, etc. 
They are sometimes recommended as nervous stimulants in cases 
of great depression, but there is always danger that the taking of 
them may become a confirmed habit, which will grow upon the 
patient. But the abuse of a thing furnishes no argument against 
its use, and we have no right to deny to some the pleasure and 
benefit which they derive from the moderate employment of alco- 
holic drinks because very many involve themselves in disastrous 
consequences from taking them immoderately. 

Besides the internal administration of alcohol, it is much used in 
evaporating and other lotions, in gargles, and collyria. It forms 
the basis of all the tinctures and medicated spirits, and in its 
several pharmaceutical forms of rectified, proof spirit, and spirit 
of French wine, is in constant request both commercially and 
medicinally. 

As a poison : when taken in large doses either as spirits of 
wine, or any of the ardent spirits, such as brandy, gin, etc., ex- 
hibiting all the effects which we see in the various stages of in- 
ebriety ; these are followed by total insensibility, coma, and death ; 



GIN.—EAU BE COLOGNE. 401 

if the system can be relieved in time of the poison, by means of the 
stomach-pump or an emetic, the life of the patient may be 
saved. The best restoratives are ammonia, given in the form 
of aromatic spirit, and strong coffee, as in case of poisoning by 
opium. 

GIN (Geneva, or Hollands). 

This is a spirit too well known and extensively used in this 
country to need any description. Containing a considerable portion 
of oil of juniper, it acts medicinally as a diuretic : when tolerably 
pure, it is not unwholesome to those whose urinary organs require 
stimulating ; but, if they are already sufficiently active, it is pre- 
judicial. But gin, as commonly sold, is a vile compound of greatly 
diluted spirit, with capsicums, or other pungent materials, to give it 
a fictitious strength ; and oil of vitriol and almond-oil, in due pro*, 
portions, to give it body, and make it bead when poured out ; per- 
haps, too, there may be a little turpentine to make up for the de- 
ficiency of the more expensive oil of juniper. Properly it should be 
made of the spirit procured from barley, or some other grain, and 
juniper-berries. How it is made, the great distillers, the spirit- 
merchants, and the publicans, can alone tell. It first came into use 
as a diuretic, and then grew into favor as a cordial stimulant, and is 
now the bane of nearly all who use it. In all cases in which gin 
would be serviceable, a diuretic medicine composed as follows would 
probably be more so : 

Take of oil of juniper, 1 drachm. 

Sweet spirits of nitre, 12 drachms. 

Oil of cloves, 6 drops. 

Simple syrup, 1 ounce. 

Water sufficient to make six ounces ; take a tablespoonful when required. 



EAU DE COLOGNE. 

This is a preparation of essential oils, or the herbs which yield 
them, containing — like lavender and other waters (so called) used 
chiefly as perfumes — a large amount of spirits. It is named after 
the place where it originated, and from whence are still sent out more 
than a million bottles annually, although perhaps not a tenth-part 
of the water which is sold under the name of eau de Cologne really 
comes from that city. In the French Pharmacopoeia is the following 
form of preparation : 



402 MATERIA MEDIC A. 

Take oils of bergamot, citron, and lemon, of each, . 3 ounces. 

Oils of rosemary, neroli, and lavender, each, . . \\ ounces. 

Oil of cinnamon, 6 drachms. 

Eectified spirits, 24 pints. 

Compound spirits of balm, 3 pints. 

Spirits of rosemary, 2 pints. 

Mix, and, after standing a week, distil twenty-four pints. 

The following is more simple, and easily prepared : 

Oils of bergamot, lemon, neroli, orange-peel, and rosemary, 

of each, 12 drops. 

Cardamom seeds, 1 drachm. 

Rectified spirits, 1 pint. 

Mix, and put by for use ; it improves by keeping. 

The grateful scent of eau-de-Cologne, and the delicious coolness 
produced when it is rubbed over the forehead, or other heated part, 
and blown upon, have long rendered it a favorite with'sick persons ; 
it is also taken internally as a stimulus in nervous debility, and the 
faintness which frequently overcomes weakly persons, especially in 
hot weather : from twenty to thirty drops in a little water, or cam- 
phor mixture, may be taken as often as required. 



CAJEPUT-OIL. 

This is an oriental medicine of great credit in the East, for the 
cure of cholera. It is a powerful stimulant and antispasmodic ; and 
now that the true nature of cholera is known, and physicians rely on 
antispasmodics for the treatment, we can understand how cajeput- 
oil obtained credit as a curative, though for a long time its influence 
over cholera was thought to be only in the fancy of dreaming 
Hindoos. Cajeput-oil causes a sense of warmth in the stomach, that 
extends to the whole system — the pulse becomes stronger and more 
frequent, and perspiration is induced. The dose is from two to six 
drops. It has been used externally as a counter-irritant in rheu- 
matism. 

CAPSICUM. 

The pungent berries of Capsicum fustigratum are employed 
medicinally ; they are powerfully stimulant, and are useful in atony 
of the stomach, and the dyspepsia of gouty and debilitated subjects. 
They are taken also with a vegetable diet, to prevent flatulency, and 
for gargles in malignant sore-throats, and relaxed states of the uvula 
and other organs of that part, as well as in chronic hoarseness. The 
dose of the powder is from two to eight grains ; of the tincture, from 



PEPPER.— CINNAMON. 403 

ten to sixty minims ; there is a concentrated tincture, good as an 
external stimulant for chilblains, and a capsicum lozenge, of which 
one may be put into the mouth and allowed slowly to dissolve, about 
three times a day. Persons who are subject to cold feet are some- 
times recommended to wear socks dusted with cayenne pepper, 
which is a mixture of the dried pods of several species of capsicums, 
but more especially of the Capsicum baccatum (bird pepper) ; 
there is commonly common salt mixed with this, and some coloring 
matter not always of an innocent nature, red lead having been de- 
tected in the composition ; if the presence of this poisonous ingre- 
dient be suspected, boil some of the powder in vinegar, filter the so- 
lution, and add to it a little sulphuret of soda ; should lead be pres- 
ent, there will be a white precipitate, which, on being dried, ex- 
posed to heat, and mixed with charcoal, will yield a globule of the 
metal. 

PEPPER. 

The pepper plant, belonging to the natural order Piperacew, is 
found in nearly all tropical countries, but chiefly in Java, Sumatra, 
Borneo, Malacca, and Hindostan. Pepper contains piperin, a very 
acrid concrete oil, on which the properties of the seeds are supposed 
to depend ; a balsamic gum ; a gummy coloring matter ; extractive 
matter, analogous to that of the leguminous plants ; gallic and tan- 
nic acid ; starch ; basorin ; lignin ; and a small quantity of earthy 
and alkaline salts. Piperin is in the form of colorless, transparent 
crystals, and without taste ; it has been recommended as a febri- 
fuge, but alone appears to have little or no action on the system. 
Pepper is well known as a warm, carminative stimulant ; it strength- 
ens the stomach, assists digestion, and gives tone to the stomach 
when taken moderately. Medicinally, we use pepper chiefly as a 
remedy for dyspepsia and flatulence. It is used, too, as a carmina- 
tive adjunct to other medicines, and the stimulus of a pepper plas- 
ter, has, like one of mustard, proved beneficial in tic douloureux and 
other neuralgic pains. An extract made from pepper will cure in- 
termittent fever, when quinine is not accessible ; and piperin, added 
to the dose of quinine, makes its action more effective and certain. 



CINNAMON. 

Cinnamon bark is an agreeable astringent and cordial, and as 
such is used with advantage in dysentery and looseness proceed- 
ing from a weakened and languid state of the bowels, and in indi- 
gestion and chronic nervous debility. It is of service in discharges 



404: MA TER1A MEDIC A. 

of blood from the uterus. It is principally used, however, as an 
agreeable aromatic adjunct to more powerful articles, as Peruvian 
bark, etc., which it causes to sit easier on the stomach. The com- 
pound powder of cinnamon is a valuable cordial and aromatic, and 
is given in doses of from eight to twenty grains. 

Oil of cinnamon is a powerful stimulant and stomachic, and is 
used as such in cramps of the stomach, flatulent colic, and nervous 
languor. The dose is from one to three or four drops on a lump of 
sugar. 

ERGOT OF RYE. 

Spurred rye, commonly called ergot of rye, is a diseased pro- 
duction which grows on the ear of rye, barley, and wheat, but most 
frequently on that of rye. The diseased grain varies much in 
length, sometimes being perfectly concealed within its husk; at 
others, growing to near an inch and a half ; its usual length is about 
an inch, and its general appearance resembles much the spur of the 
cock. 

This substance has been known to possess deleterious and poi- 
sonous qualities, for more than seven hundred years. If taken in 
considerable quantity, mixed with the healthy grain as food, it pro- 
duces giddiness, spasms, and convulsions, on which gangrene and 
sloughing of the lower limbs supervene. From this cause, an epi- 
demic raged in the kingdom of Hesse, in 1596, and in both Saxony 
and Sweden, in 1648-'49, and, twenty years after, in Blois and Mon- 
targes, in France. In 1777, a similar epidemic from the same cause 
ravaged Cologne and its neighborhood, and since that time, in dif- 
ferent years, its baneful influence has been more or less remarked in 
France. Some persons thought the deaths might be owing to great 
vicissitudes in the weather and temperature ; but the various experi- 
ments of a M. Tessier, on animals removed out of the influence 
of such exciting causes, fully prove the accidents were attributable 
to the grain itself. 

The action of this medicine as a specific uterine stimulant gives 
it great value in certain cases of labor. When there is no dispro- 
portion between the size of the head and the pelvis, and no obstruc- 
tion to the passage of the child, and when labor comes to a stand- 
still simply through the mother's exhaustion, or failure of uterine 
pains, then give the ergot ; it will cause powerful expulsive efforts. 
But, if the effort thus stimulated fails to expel the child, the child 
will be poisoned and destroyed by the ergot. Therefore, never give 
it unless the child is in such position that four or five hard pains 
will insure delivery. 



GINGER— ETHER. 405 

The dose of the ergot of rye in powder (which is of a perfect ash 
color) is from five to twenty or twenty-five grains. The ordinary 
dose is fifteen grains, which may be repeated in a quarter of an 
hour, if the uterine action has not become apparent. It may be 
given in infusion or in tincture ; a drachm of the tincture is a full 
dose. 

GINGER 

Is valuable for its pungent, aromatic, heating, stimulant proper- 
ties. In tincture, infusion (ginger-tea), or in syrup, it acts equally 
with great efficacy, as an intestinal stimulant. It is commonly used 
as a remedy against flatulent colic, and there is hardly a more effec- 
tive diuretic in use than the hot ginger-tea that any good nurse will 
prepare from the common ground ginger. 

ETHER. 

A highly volatile fluid, produced by the action of acids on al- 
cohol ; thus we have acetic, hydrochloric, or muriatic, nitric, nitrous, 
and sulphuric ethers, and of some of these more than one form of 
preparation. The first of these {Ether aceticus) is much employed on 
the continent — internally, as a mild stimulant, diaphoretic, antispas- 
modic, and nervine ; the dose is from five to thirty or forty drops ; 
externally, in stimulating liniments ; and, by itself, in gentle friction, 
for gout. The second (M hydrochlorides) is diuretic and diaphoretic, 
in doses of ten to thirty minims ; there is also a spirit of muriatic 
ether not so strong, the dose being from twenty minims to one 
drachm. The third (E. nitricus) and the fourth (E. nitrosus) are 
both mildly stimulant, and more decidedly diuretic than the others, 
if the patient is kept warm ; the dose of the latter is from ten to 
twenty minims ; the former, which is generally sold in a diluted 
form, as sweet spirits of nitre, may be given in drachm doses ; it is a 
favorite remedy in colds, especially if attended with febrile symptoms 
and obstructions of the urinary passages. The fifth (E. sulphuricus) 
is, in its diluted form of spirits of sulphuric ether, the kind to which 
the name ether is most generally applied ; it is a diffusible stimulant 
much employed, on account of its rapid effects, in spasmodic asthma, 
cramp of the stomach, colic, hiccough, paljntation, fainting, and other 
spasmodic and nervous affections ; the dose is from twenty minims 
to half a drachm. Applied externally, it produces cold by its rapid 
evaporation ; or, if the vapor is confined, it acts as a stimulant and 
rubefacient. Its inhalation produces insensibility to pain, and, be- 
fore the introduction of chloroform, it was much used in painful 



406 • MATERIA MEDIC A. 

and protracted operations. There is a compound spirit of sulphuric 
ether, sold under the name of Hoffman's anodyne solution, which 
was once extensively used as a nervous stimulant ; the dose, half a 
drachm to one drachm. There is also an aromatic spirit of ether, 
prepared with spices — a grateful but not a very useful stimulant. 
There is, too, an ethereal oil ( Oleum ethereum) which is only used 
as an ingredient in the compound spirits of ether. Chloric ether is 
a solution of chloroform in alcohol. 



HOFFMAN'S ANODYNE. 

This is the compound spirit of sulphuric ether of the shops, and 
is stimulant, narcotic, and antispasmodic. It is used for the same 
purpose as the common sulphuric ether, and is sometimes useful in 
allaying irritability and disposing to sleep, in the latter stages of 
typhus and other malignant fevers. It is less exciting than simple 
ether. When united to opium, for the purpose of procuring sleep, 
it renders the operation of the opiate more pleasant, and counteracts 
its deleterious properties. The dose is from half a drachm to a 
drachm, in any simple fluid vehicle. 

All ethers should be kept in closely-stopped phials. 



CHLOROFOKM. 

This is a colorless, heavy liquid, with a peculiarly agreeable, 
fruity, ethereal odor. When rubbed on the skin it quickly evapor- 
ates, and, if pure, leaves no odor. 

Its action when taken internally is narcotic and antispasmodic, 
like that of ether; but it has a more distinctly marked sedative 
effect, and in large doses it diminishes sensorial power, and produces 
drowsiness, without exhilaration or acceleration of the pulse. It 
has been employed in spasmodic affections, such as spasmodic coughs, 
asthma, and cholera, and also in insanity ; but we do not yet know 
enough of its powers to say much in favor of them. 

Its chief employment is in a form of vapor, for the production of 
insensibility during severe labor, or surgical operations; and also 
during the passage of gall-stones, and in violent attacks of colic, in 
which its use has been sometimes followed by great relief. But it 
requires to be used with extreme caution, and is not at all suitable 
or safe in domestic practice. Indeed, it cannot be safely adminis- 
tered except by a practised professional man. The proper mode of 
administering chloroform is on a napkin or handkerchief. The cloth 
should be wet with a small portion at a time, and this applied to the 



SA VIN.— AMMONIA. 407 

nostrils. By this means the person inhaling the chloroform gets at 
the same time sufficient air. 

To recover a person from an overdose, the best treatment is to 
sprinkle a little cold water on the face — to rub the limbs in the direc- 
tion of the veins toward the heart — to open all the windows and 
let in as much fresh air as possible — to turn the patient over on his 
right side, and fan fresh air with a fan on his chest and neck, and to 
place a teaspoonful of brandy now and then on the tongue. The 
machinery of the heart is at a stand-still, and, if we once excite that, 
all is right. Attempts at recovery ought not to be given over for 
at least two hours. 

SAVIN. 

The leaves of the Juniperus sabina — an evergreen cultivated in 
the United States as an ornamental shrub — contain an essential oil 
that is an effective uterine stimulant. The medicine may be given 
in the powdered leaves, in a decoction, or in extract. It is an effec- 
tive emmenagogue in amenorrhea, and regulates the action of the 
uterus in passive haemorrhage and in menorrhagia. The powder of 
savin may be given in from five to twenty grains, two or three times 
a day, in combination either with other emmenagogues or with aro- 
matics. 

AMMONIA. 

A volatile alkali, most commonly seen under the form of car- 
bonate and subcarbonate, the volatile salts of commerce. Its med-* 
ical properties are stimulant, diaphoretic, antispasmodic ; in large 
doses, emetic. It is given in convulsive disorders, gouty acidities of 
the stomach, nervous affections, debility, the flatulency and acidity 
arising from dyspepsia, and the gastric affections which result from 
habits of intemperance and debauchery. Combined with opium, it 
is good in chronic diarrhoea, and, in large doses, in the muscular 
relaxation of long-standing rheumatism, in hoarseness, or a relaxed 
state of the throat and bronchial organs. It has been recommended 
in typhus fever ; its use as a stimulant and restorative in syncope and 
hysteria, in the form of smelling salt, is well known. The dose of 
the carbonate of ammonia is from five grains to a scruple in bitter 
infusion, camphor mixture, or any convenient vehicle ; the officinal 
preparations into which it enters are: liquor of subcarbonate of 
ammonia — dose, twenty minims to one and a half drachm ; liquor of 
acetate of ammonia, two to six drachms ; ammoniated copper, one 
half to five grains ; liniment of the subcarbonate of ammonia, for 
27 



408 MATERIA MEDIC A. 

external use only. The second of these is a febrifuge and diaphoretic, 
often prescribed in combination with other medicines of its class. 
It is also a good application for bites and stings, and inflammatory 
eruptions. 

The aromatic and fetid spirits of ammonia (spiritus ammonice 
aromatieus et foetidus) of the pharmacopoeia are both much used as 
nervous stimulants and antispasmodics ; dose, half a drachm to a 
drachm in water or camphor mixture ; they are valuable additions 
to tonic mixtures, the former, especially, for lowness of spirits; and 
the latter, where there is flatulency. The strong liquor of ammonia 
is too caustic for internal administration, but is sometimes given, as 
is also the common hartshorn (liq. volatile cornu cervi) in hysteria, 
etc. Most usually and properly, however, these preparations are 
employed for external application only ; their pungent vapor is ap- 
plied to the nostrils of fainting persons, and they are mixed with 
oleaginous and other substances for liniments, to produce counter 
irritation. 

The compound tincture of ammonia (tinctura ammonice composi- 
tus) is composed of gum mastic, oil of lavender, rectified spirits, and 
strong solution of ammonia : this is the old eau de luce with the oil 
of amber omitted ; it is a good stimulant and antispasmodic ; dose, 
from five to ten minims in water. There are several other ammo- 
niated tinctures in the pharmacopoeia, such as castor, colchicum, 
guaiacum, opium, valerian, and various other officinal preparations 
into the composition of which ammonia enters, such as ammoniated 
iron, ammonio-chloride of mercury, acetate, citrate, and tartrate of 
ammonia ; these neutral salts are all used as diaphoretics, are given 
in febrile diseases, and in dropsy and rheumatism. The acetate, 
as well as the carbonate and pure ammonia, is sometimes taken 
by drunken persons to recover them from the effects of their 
potations ; the former is now only given in the form of liquor am- 
monia acetatus y the popular name of this was formerly spirit of 
Mindererus. 

The other ammoniacal salts employed in medicine are — the ni- 
trate, nitro-sulphate, phosphate, sulphate, hydro-sulphuret, and succi- 
nate of ammonia : the first is refrigerant and diaphoretic — dose, from 
three to twenty grains ; equal parts of this and carbonate of soda 
form a powerful freezing mixture ; the second is given in typhoid 
fevers — dose, about twelve grains; the third is good in some cases 
of rheumatism — dose, three to ten grains ; the fourth is diuretic, 
stimulant, and resolvent — dose, fifteen to thirty grains ; the fifth is 
poisonous in large doses ; in small, say from four to eight drops, it 
is good in catarrhal complaints, diabetes, and gout ; the sixth is anti- 



AMMONIACUM.— POTASH. 409 

spasmodic ; it is usually given in the form of liquor ammonice sued- 
natus — dose, from fifteen to ten drops. The hydrochlorate, or 
muriate of ammonia, is an article much employed in the useful 
arts, under the name of sal ammoniac; it is given in inflam- 
mation of the mucous membrane, when the more active stage 
has passed, and in chronic bronchitis; also in intermittent fever, 
and chronic enlargement of the prostate — dose, from five to 
twenty grains every three or four hours ; its action requires to be 
carefully watched in persons of feeble constitutions, and those sub- 
ject to haemorrhages. It makes a good lotion for indolent tumors 
and chilblains ; mixed with nitrate of potash, or saltpetre, is power- 
fully refrigerant, and may be employed with advantage in gargles, 
which see. 

AMMONIACUM. 

Commonly called gum ammoniac, a resinous gum which exudes 
from the Dorema ammoniacum, a plant of the natural order Umbetti- 
ferae. 

This gum is stimulant, antispasmodic, and expectorant ; in large 
doses, gently purgative, and sometimes diuretic; it is useful in 
asthma, whooping-cough, visceral obstructions, and in some stages 
of phthisis, and in mesenteric obstructions, after the exhibition of 
gentle aperients. Dissolved in nitric acid, it is given with great 
advantage to promote expectoration, where large accumulations of 
phlegm are present ; while externally it is useful as a discutient and 
resolvent in scirrhous tumors and indolent ulcers. Its chief offici- 
nal compounds are mixture of ammoniacum — dose, one-half to one 
ounce ; compound squill pill, ten grains to one scruple ; plaster of 
ammoniacum with quicksilver, and gum plaster. Rubbed down 
with cold water, which would seem to be its proper solvent, it makes 
a milky fluid, and, if to a pint of this be added the yolk of an egg, 
with two drachms of tincture of squills, and half an ounce of syrup 
of poppies, and the same of paregoric elixir, it makes an excellent 
cough mixture. 

POTASH. 

Many of the preparations of this substance are used medicinally, 
and are justly esteemed as among the most efficacious of remedies. 

The caustic, or fused potash, is powerfully escharotic, and is 
sometimes employed in the formation of issues and in the destruc- 
tion of extraneous growths ; being combined with lime, it is more 
manageable, as well as effectual. 

Acetate of potash is mildly cathartic, diuretic, and deobstruent ; 



410 MATERIA MEDIC A. 

it is useful in febrile diseases, dropsies, icterus, and visceral obstruc- 
tions — dose, from one to three scruples ; as an aperient, from two 
to three drachms. 

Carbonate of potash is diuretic, antacid, and deobstruent ; use- 
ful in dropsy, acidity of the stomach, and glandular obstructions ; 
dose, ten to thirty grains, properly diluted. One scruple, dissolved in 
eight ounces of water, and four drachms of lemon-juice, make a 
pleasant effervescent draught. 

Bicarbonate of potash has the same properties as the last, but 
is less acid. 

Iodide of potassium is much used in secondary syphilis ; it is 
a good alterative, and very serviceable in skin diseases and viti- 
ated states of the system generally ; the dose is from two to ten 
grains. 

Nitrate of potash, or saltpetre, is diuretic and refrigerant; in 
large doses, purgative; externally, cooling and detergent. Much 
used in rheumatism, dropsies, fevers, herpetic eruptions, active 
haemorrhages, gonorrhoea, etc. A small piece allowed to dissolve 
in the mouth often removes incipient cynanche tonsillaris. Hence 
its utility in gargles. 

Sulphate of potash. — This is the Kali vitriolatum of the old 
pharmacopoeias. It is deobstruent and purgative, and . is employed 
in visceral obstructions. As a purgative it must be taken in half 
ounce doses ; as a deobstruent, from one to three scruples. 

Sulphuret of potash is expectorant, diaphoretic ; externally, de- 
tergent. Dose, from five to fifteen grains, in pills, twice a day. 

Supersulphate of potash is refrigerant and purgative. Given in 
cases where it is desirable to exhibit sulphuric acid, and at the same 
time open the bowels. The dose is from one scruple to two 
draohms. 

Supertartrate of potash, commonly called cream of tartar, is 
mildly purgative, refrigerant, and diuretic. Dissolved in water, 
with a little white wine, sugar, and lemon-peel, it makes the pleas- 
ant diet drink called Imperial. Dose, one to three drachms, com- 
bined with one scruple of borax, to excite the kidneys ; to open the 
bowels, four to eight drachms. 



SODA. 

Many preparations of this substance are used medicinally ; in 
its general action it is antacid and antilithic, diuretic, diaphoretic, 
and antiphlogistic ; it is given in dyspepsia, heartburn, flatulency, 
gouty and rheumatic affections, lithic deposits in the urine, coughs 



SODA. 411 

and mild inflammations. We give a list of its principal forms of 
administration : 

Carbonate and bicarbonate, the latter being formed by satura- 
ting the former with carbonic acid gas ; it is more generally used 
than the carbonate, being milder and less irritating; dose, from one 
to ten grains for children, from the latter quantity up to a drachm for 
adults ; effervescing draughts and soda water are prepared from this. 

Acetate, Citrate, and Tartrate. — The first is a white soluble salt, 
with a pungent bitter taste ; given in doses from a scruple to a 
drachm as a diuretic, from two to four drachms as a purgative ; the 
second and third are formed when an effervescing draught is made 
of the carbonate with citric or tartaric acid. 

Biborate. (See Borax.) 

Potassio Tartrate. (See Rochelle Salt, and Seidlitz Powders.) 

Phosphate. — Made by adding a solution of the carbonate to one 
of the superphosphates of lime obtained from bone earth ; this is a 
mild saline cathartic, having little taste ; it is therefore less likely to 
cause nausea than some others ; it may be safely given in fevers, and 
inflammatory affections even of the bowels, and to pregnant women ; 
it is a good solvent for lithic deposits, and is therefore useful in gouty 
and rheumatic disorders ; it is given to rickety children, with the in- 
tention of supplying the deficiency of phosphoric acid in the bones. 
Dose, as an antilithic, etc., from one to two drachms ; as a purgative, 
from half an ounce to three times the quantity, in gruel or broth. 

Sulphate and Hydrosulphate. — The first of these substances has 
been recommended for destroying fungous growths in the stomach 
and elsewhere. The dose is from half a drachm to twice or thrice 
that quantity. The hydrosulphate is used in photography as a sol- 
vent for iodide of silver ; it is also used to destroy parasitic vegeta- 
tion in the same way as the former preparation. On the continent 
it is given as an alterative in skin diseases, and it may be given as a 
purgative in the same way as the sulphate — dose, ten grains to a 
drachm ; as a cathartic, two to four drachms. 

Chloride of Sodium. (See Common Salt.) 

Chlorinated soda owes its properties to the larger proportion 
of chlorine which it contains ; it is a good antiseptic and deodor- 
izer, and is sometimes administered as a stimulant and anti-putres- 
cent in typhus and other malignant diseases, as well as in chronic 
affections of the liver. Externally, it is applied, largely diluted, to 
foul, indolent ulcers, and the sores caused by some cutaneous dis- 
eases ; it is also used as a gargle in putrid sore throat, and a mouth- 
wash, where there is fetid breath from decayed teeth or ulcerations. 
as well as in local baths for hepatitis, etc. 



412 MATERIA MEDIC A. 

There are other preparations of soda which are sometimes em- 
ployed medicinally ; but the above are all we need mention, except 
soda water, which, when properly made, contains about twenty 
grains of the bicarbonate to the half pint, and is strongly impreg- 
nated with carbonic acid gas ; it is best prepared in a machine, or a 
gazogene, although it may be prepared for immediate use by dis- 
solving two scruples of bicarbonate of soda in half a pint of water, 
and adding half a drachm of tartaric acid. 

LIME. 

Lime in lime-water {liquor calcis) is given internally as an 
astringent, antacid, and alterative in diarrhoea, vomiting, heart- 
burn, and other irritations of the stomach and bowels, resulting 
from acidity. Acting as a solvent upon the mucus, it is occasionally 
given to dislodge worms ; and it will sometimes, when added to a 
milk diet, enable a weak stomach to tolerate that which it would 
not otherwise be able so to do. A little milk mixed with it renders 
it less acrid and unpalatable than it naturally is. Lime-water 
may be easily prepared for family use, thus : Take of unslaked lime 
about half a pound ; fresh rain or distilled water, twelve pints ; first, 
slake the lime with a little of the water ; mix it up well, adding 
gradually the rest of the water ; then, put the whole into a well- 
stopped bottle ; when wanted for use, pour off the clear liquor. 
Equal quantities of this and olive-oil make an excellent application 
for bums. 

Carbonate of lime {calcis carbonas) is used in the form of pre- 
pared chalk, prepared oyster-shells, and crabs'-claws, as an antacid 
and astringent, for diarrhoea, heartburn, and acidity of the stomach. 

Chloride of lime is extensively used in solution as a disinfect- 
ant ; it is also sometimes administered in putrescent fevers, as a 
stimulant and antiputrescent ; largely diluted, it is applied to foul, 
indolent ulcers, and to some forms of cutaneous diseases : it also 
makes a good gargle in putrid sore throat, and a mouth-wash, where 
there is fetid breath from decayed teeth or ulcerated mouth, and a 
local bath in hepatitis. This is the common bleaching salt of which 
the bleaching liquid is made. 

Phosphate of lime is strongly recommended by some in rickets, 
scrofula, diarrhoea, ulcerations, excoriations of the skin and bowels, 
and general waste of the tissues of children ; it also promotes the 
cicatrization of ulcers and the union of fractures ; but in the latter 
case should not be given too freely, lest the callus be too abundant, 
so as to cause permanent deformity of the limb ; the dose for adults 



opium. 413 

is from foui' to six grains ; for children, two or three grains, three 
times a day. 

Sulphuret of lime (calcis sulphuretum) is sometimes prescribed 
in skin diseases, gout, and chronic rheumatism; it is alterative, 
stimulant, and diaphoretic, and, in doses of twenty grains, is given 
as an antidote to metalic poisons ; the common dose is from four to 
eight grains. It is chiefly used, however, in the composition of sul- 
phur baths, being, for this purpose, more economical than sulphuret 
of potassium. To prepare a bath, two or three ounces are dissolved 
in the water, and from twenty to forty drops of sulphuric acid added. 

The general action of lime upon the human system varies ac- 
cording to the form in which it is exhibited ; thus quick-lime is es- 
charotic, causing inflammation, and often decomposition, of the 
part which it touches ; when slaked, and in a state of great dilu- 
tion, as in lime-water, we find that it scarcely has any immediate or 
direct action; it merely combines with and neutralizes the acids of 
the stomach, and, if in considerable quantities, absorbs the mucous 
and other secretions, checking also those of the organs with which it 
is brought into contact. After it has been absorbed into the sys- 
tem, it appears to augment the secretions of the kidneys, and to 
keep down the excess of uric acid. Altogether, it is one of the 
medical man's most valuable adjuncts. 

OPIUM. 

This is the partially dried juice of the white or eastern poppy 
— the Papaver somniferum. It is obtained by cutting the unripe 
capsule, from which a white juice exudes, and appears in the form 
of tears on the edges of the incisions ; this is scraped off, put into 
earthen vessels, moistened with saliva, and then worked up, with a 
wooden spatula, in the sun, until it attains a proper consistency ; 
it is then formed into cakes, and wrapped up in tobacco or poppy 
leaves, in which state it is the opium of commerce, having, by ex- 
posure to the air, assumed a dark color. This is, perhaps, the most 
important drug in the whole range of materia medica; applied 
externally, it acts as a sedative, lulling pain ; given internally, in 
moderate doses, its first effect is that of an excitant ; it quickens 
the pulse and increases the heat of the skin ; but these symptoms 
are soon followed by a diminution of sensibility and a tendency to 
sleep ; if pain is present, it is abated or altogether banished, irrita- 
tion is diminished, and the muscular system relaxed ; the secretion 
of the bowels is lessened by it, but that of the skin increased, and 
thus it acts as a sudorific. When taken continually in small doses, 



414 MATERIA MEDIO A. 

it causes a kind of intoxication; in overdoses it is a narcotic 
poison, causing deep sleep, with contraction of the pupil of the eye, 
which results in coma and death. 

Opium is undoubtedly the best anodyne and soporific with which 
we are acquainted ; but on certain systems its action is directly op- 
posite to that which we commonly look for ; therefore, it is necessary 
to watch its effects very carefully. Bearing in mind that its prima- 
ry operation is that of an arterial stimulant, we should avoid giving 
it in states of cerebral excitement ; a parched tongue and a dry 
skin should generally forbid its use ; but if there is only moderate 
fever, with a moist skin, and no cerebral disorder, it may be safely 
administered to alleviate pain and subdue irritation : in bronchitis, 
combined with camphor and ipecacuanha — as in paregoric and 
Dover's powder ; in cancer, delirium tremens, and all neuralgic dis- 
orders, it is constantly prescribed; in convulsive disorders, it is 
given as an antispasmodic ; in many cases, as a diaphoretic ; and in 
dysentery and diarrhoea, alone, or combined with astringents, there 
is no medicine so good as this. 

The narcotic properties of this drug are chiefly owing to the al- 
kaloid morphia ; of this, good opium contains about twelve per cent. It 
is somewhat less stimulating in its action than the juice of the poppy, of 
which it is the most active principle, in combination with meconic acid. 

One grain of morphine is equivalent to six grains of opium ; and, 
where one grain of opium is given as a dose, the analogous dose of 
morphine would be one-sixth of a grain. 

The common dose of opium for an adult is from one to three 
grains ; "for children, it should be given in very minute doses, if at 
all, and is best avoided altogether. Opiates should never be given 
to the young, except there is a pressing necessity for them, and 
then very carefully, and not often. 

There are many officinal preparations of opium ; we give a list 
of the principal, with their doses : extract, one-half a grain to 
three grains ; pill, five to ten grains ; the same, with calomel, five to 
ten grains ; lozenges contain each one-tenth of a grain of the extract ; 
tincture (laudanum), ten to thirty drops ; ammoniated tincture, about 
one drachm ; wine, ten to sixty minims. 

There are several preparations which owe their chief activity to 
the opium which they contain, although the name of the drug does 
not appear in their titles : such are the compound powders of ipeca- 
cuanha ; the compound ipecacuanha pills, and pills of ipecacuanha 
with squills ; also, the compound soap and storax pills ; the com- 
pound powder of chalk with opium, much used in dysentery and 
diarrhoea ; and the compound tincture of camphor — paregoric elixir. 



BELLADONNA. 415 

Opium-eating has in this, as in other countries, assumed the 
character of a disease ; by many persons it is carried to a great ex- 
tent. Those who are habituated to the use of this deadly drug re- 
quire constantly increasing doses, and become in time, like spirit- 
drinkers, complete wrecks both in body and mind. They generally 
begin with small quantities, just enough to lull bodily pain, or soothe 
mental disquietude ; but the habit, if encouraged, grows upon and 
eventually enslaves them. 

BELLADONNA. 

This is the deadly nightshade, a very poisonous plant. It has 
a purple, bell-shaped blossom, about an inch long, and oblong, 
pointed leaves, growing on short stalks, generally in pairs ; the 
stem is upright, stout, and rather hairy, sometimes altogether green, 
but oftener tinted with red ; the berries are about the size of wild- 
cherries, of a dark-purple color, glossy, sweet, and not unpleasant 
to the taste ; hence they have been often eaten by children, ignorant 
of their deleterious qualities, with fatal results. 

The leaves, roots, and berries, indeed every part of this plant, 
are powerfully narcotic, and act in some cases as a diaphoretic, 
diuretic, and laxative. Medicinally, it is employed to alleviate pain, 
great nervous excitement, and spasms ; it is also useful in neuralgic 
and convulsive affections, as well as in rheumatism, dysmenorrhcea, 
etc. Its powerfully poisonous nature, however, renders great cau- 
tion necessary in its administration, and it should never, on any ac- 
count, be resorted to by unqualified persons. Dryness and constric- 
tion of the throat, dimness of sight, and giddiness, are the symptoms 
of the necessity for its discontinuance. The following are its officinal 
preparations, with their doses : — Powdered leaves, one grain, once 
or twice a day, gradually increased to two or three grains, under 
careful supervision ; the powdered root is sometimes used — it is 
thought to be rather stronger ; extract, from one-eighth to one- 
quarter grain, twice a day — for a child, one-twelfth grain ; alcoholic 
extract, from one-sixth to one-quarter grain ; tincture, from five to 
twenty minims, equal to from one-half grain to two grains of the 
dried leaves ; atropine and sulphate of atropine, the active princi- 
ple of belladonna, is seldom given internally, and when so given the 
dose should not exceed the sixtieth part of a grain. 

For external use it is employed in the form of cerate, cataplasm, 
liniment, lotion, oil, plaster, solution, ointment. The vapor of the 
decoction is sometimes inhaled to relieve asthma, and the extract is 
applied to relieve pain, and dilate the pupil of the eye. 



4:16 MATERIA MEDIC A. 

STRAMONIUM, OR THORN-APPLE {Stink Weed). 

This is an acrid narcotic poison, and appears to exercise much 
the same influence on the human system as belladonna. It is some- 
times given for the purpose of quieting the mind during violent par- 
oxysms of insanity. The claim which was some years since set up 
for it, as a specific in severe chronic pains of the head and other 
parts of the body, may be well disputed, and its dangerous nature 
should prohibit its internal administration in any cases to which 
other remedies can be applied. When given it should be in the 
form of tincture or extract — dose of the former, from ten to twenty 
minims twice a day, in water ; of the latter, from one-quarter to 
one-half a grain, which may be gradually increased to four grains 
in twenty-four hours. 

Smoking the herb, after the manner of tobacco, sometimes affords 
relief in spasmodic asthma ; this has become a common practice of 
late, and with some persons it has proved very mischievous ; it may 
be safely followed, although not to excess, by those with whom it 
produces no sensation of giddiness, or other bad head-symptoms. 
The poorer Turks smoke this instead of opium, and the Ceylonese, 
when asthmatic, have done so time out of mind. 

HYOSCYAMUS. 

This is a strong narcotic poison, the leaves and seeds being 
chiefly used for medical purposes ; the latter are the most active. 
There are two cultivated varieties of this plant, one annual and the 
other biennial ; the latter is considered the most active. The plant 
which grows wild on waste and ruinous places is commonly about 
three feet high, with a hairy stem, and large, deeply-indented leaves 
of dull, sickly-looking green. It bears, from June to August, dull 
yellowish- white blossoms, thickly marked with purple lines ; it has a 
peculiarly fetid and unpleasant odor. This plant is much used in 
modern medical practice, as it is found to allay pain, and subdue 
nervous excitement, without confining the bowels, and acting other- 
wise prejudicially, as opium often does ; in irritable affections of 
the lungs, bowels, and other organs, its sedative properties render 
it extremely valuable. The dose of the powdered leaves is from 
one-half a drachm to two drachms; of the tincture, one-half a 
drachm to two drachms ; of the extract (the most common form of 
administration), from one to five grains. There are also cataplasms, 
plasters, and oil of hyoscyamus, intended for external use. In over- 
doses, henbane causes delirium, coma, and death, and its operation 
is in general very rapid. 



CONIUM.— HOPS. 417 

These seeds contain an alkaloid principle called hyosciamine, 
combined with malic acid. It is in the form of transparent, color- 
less, needle-shaped crystals, without odor, and with a disagreeable 
taste. The root of the plant has been mistaken for chicory, and it 
is related that the whole inmates of a convent once were victims to 
such a mistake. It is violently emetic, and necklaces are sometimes 
made of it, to be worn by children subject to convulsions, under the 
false impression that they will effect a cure ; these roots are bien 
nial, and are more energetic in their action the second year than the 
first. 

CONIUM. 

This is a powerful narcotic poison ; this principle residing chiefly 
in the leaves and seeds. The roots are said to have, when boiled, 
very much the taste of parsnips ; but we should not recommend 
any of our readers to make a meal of them, as it is likely that, in 
certain states of the atmosphere, or conditions of growth, they 
too may be poisonous. We give conium as an anodyne, antispas- 
modic, and deobstruent ; but, in scirrhous and cancerous diseases, 
only as a palliative ; also in pulmonary irritation, whooping-cough, 
neuralgia, chronic rheumatism, and all cases in which sedatives are 
likely to be of service ; in skin diseases and enlarged viscera, too, it 
is given, and several other diseases. The dose of the leaves, dried 
and powdered, is two or three grains, gradually increased until 
slight nausea, or giddiness, is produced; of the extract, from- two to 
three grains, once a day, increased as above ; of the compound pill, 
from three to five grains, two or three times a day ; tincture, from 
twenty to forty minims. There are two other preparations of this 
plant, but they are very rarely employed. The ointment and plas- 
ter are anodyne and resolvent, and the dried leaves, mixed with a 
carrot or other poultice, and applied twice a day, correct the 
foetor of a cancerous discharge in a very short time, and alter the 
discharge into good pus^. 

The activity of conium is much diminished by acids ; hence, in a 
case of poisoning by this plant, vinegar would be a good and easily 
procured remedy ; of course, the stomach should be relieved of as 
much of the poison as possible by emetics. 



HOPS. 

The Strobiles of Hamulus JOupulus. — They contain several ele- 
ments of activity ; thus the bitter principle is tonic, the aromatic 
warm and stimulating; they are also astringent and slightly ano- 



418 MATERIA MEDIC A. 

dyne, so that a pillow stuffed with them is considered to promote 
sleep, and a fomentation to allay the pain and irritation of angry tu- 
mors. They yield an aromatic oil, and a substance called lupuline, 
in which the bitter property resides, that is, the tannin, and to a 
considerable extent their peculiar aroma also. We find them in the 
pharmacopoeia in the form of extract, infusion, and tincture, which 
we give in cases of gout and rheumatism, and diseases of the 
stomach, where other anodynes could not be taken. The dose of 
the infusion is from one quarter of an ounce to two ounces ; of the 
extract, from ten grains to twenty ; and of the tincture, from half 
a drachm to one drachm ; the second is made by infusing one ounce 
of the flowers in two pints of boiling water ; and the third, by 
macerating six ounces of the flowers in two pints of proof spirit. 
The highly-hopped pale ale or bitter beer is a good medicinal tonic ; 
but its regular use for a lengthened period is not desirable, except 
in very warm climates. Heated in a flannel bag, hops are a com- 
mon remedy for toothache and neuralgic pains, and the young 
shoots of the plant are in some places eaten like asparagus, for 
which they form a tolerable substitute. 



CAMPHOR. 

Camphor is a concrete vegetable juice, white, brittle, and of a very 
peculiar, fragrant, penetrating odor, and bitter, pungent, and aro- 
matic taste. It is so extremely light that it floats upon water, and 
is extremely volatile and inflammable, burning with a brilliant light 
and much smoke ; it is soluble in water to the extent of about half 
a grain to an ounce ; alcohol will take up half the weight of the 
gum ; oils, both fixed and volatile, will dissolve a considerable quan- 
tity, especially if their temperature be raised ; sulphuric and other 
ethers are among its most potent solvents, but the most so of any 
is strong acetic acid. It may be suspended in mixtures by tritura- 
tion with sugar, almond emulsion, mucilage, or yolk of egg : if 
rubbed down first with a small quantity of spirit, it readily blends 
with any desirable liquid. In its medical properties, camphor is 
diaphoretic, antiseptic, stimulant, antispasmodic, narcotic, and ex- 
ternally anodyne. It is good in typhus, confluent small-pox, and all 
fevers and eruptions of the typhoid class ; also in measles, febrile 
delirium, hiccough, asthma, hysteria, epilepsy, atonic gout, mania, 
melancholy, and acute rheumatism, etc. It exhilarates in moderate 
doses, and raises the pulse without producing febrile symptoms ; it 
also promotes perspiration, and, in certain states of the body, it in- 
duces sleep when opium fails to do so ; but its effects are transient, 



HYDRO CYANIC ACID. 419 

and therefore it requires frequent administration. It is, to a certain 
extent, a corrective of the bad effects of drastic purges, diuretics, 
powerful stimulants, and narcotics ; if taken in excessive doses, it 
occasions anxiety, vomiting, syncope, and delirium, for all which ef- 
fects opium is the best counteracting remedy. It is given in doses 
of from five to twenty grains, in pills, powder, and emulsions ; its 
chief officinal preparations are : camphor mixture — dose, from one to 
two ounces, made by simply putting a lump of the gum in cold 
water, and letting it stand for a few hours ; tincture of camphor — 
dose, thirty to sixty minims; compound ditto (Paregoric Elixir), 
one to three drachms ; camphorated emulsion — dose, from half an 
ounce to two ounces ; camphor liniments, simple and compound, 
soap liniments, and spirits of camphor, are used externally as stimu- 
lants and counter-irritants. Rubbed down with prepared chalk, in 
the proportion of one drachm to the ounce, it makes a good tooth- 
powder ; sniffed up the nostrils, it relieves cold in the head ; the va- 
pors, inhaled by means of a tube, like a cigar, are useful in affections 
of the chest ; a piece held in the mouth is thought to be a good pro- 
tection against fevers and other infectious diseases; finally, its 
strong odor protects animal substances from the ravages of insects. 



HYDROCYANIC ACID. 

This is more commonly called prussic acid. It is a most power- 
ful sedative poison, but, skilfully employed in small doses, it is 
sometimes very useful in pulmonary consumption, and spasmodic 
coughs of every description, particularly asthma, chronic cough, and 
whooping-cough. Linnaeus informs us that it was frequently used in 
Holland in pulmonary consumption, and many eminent medical men 
have thought highly of it as a remedy in this complaint, and in 
spasmodic coughs. It would seem to be most beneficial in coughs 
originating in great irritation and disease in the windpipe. It is 
also useful in those instances of indigestion which are attended with 
pain and acidity of the stomach, and accompanied with heat and 
soreness of the tongue ; but, upon the whole, it is much inferior to 
many other remedies for this disorder. The dose is from two 
to eight drops, which may be taken in distilled water, almond 
emulsion, or infusion of Peruvian bark, and repeated twice a 
day. 

As a local application, it is very efficacious in allaying the itching 
and tingling which are so distressing in tetters and other cutaneous 
eruptions, which appear on the face, head, hands, etc. ; and it not 
only allays the itching of these pustules, but will often be of much 



420 MATERIA MEDIC A. 

service in promoting their cnre. The lotion for external use is 
made by mixing a drachm of the hydrocyanic acid with an ounce 
and a half of rose-water, with which the part affected may be 
washed three times a day. It may be used advantageously in the 
following combination : two drachms of the prussic acid, sixteen 
grains of the acetate of lead, half an ounce of spirit of wine, and 
eight ounces of distilled water, which are to be mixed together for a 
lotion. This soothes the irritability of the diseased surface, and dis- 
poses the skin to renew its healthy action. 

The cherry-laurel water acts in the same way as the medicinal 
prussic acid, but is less energetic. The dose is from six drops to 
half a drachm. It is much used in some countries. Only a diluted 
hydrocyanic acid is used in medicine. The pure acid is dangerous 
even to handle. 



ACONITE {Monk's-hood). 

This medicine consists of the root or leaves of Aconitum napellus 
in powder, extract, and tincture. 

It depresses certain of the vital functions, such as respiration, 
the action of the heart, and the sensibility of the nerves, in a re- 
markable degree, and consequently is a valuable agent when the 
system is deranged through an exaggerated activity of those func- 
tions. It is principally useful in fever, in some inflammations, and 
in neuralgia. It is especially excellent in facial neuralgia, and in 
nervous headache. In neuralgia it may be given in doses of two 
or three drops of the tincture — or the tincture, or an ointment made 
from the powder, may be applied externally. It is of value in ery- 
sipelas, and has been reputed to be almost specific against acute 
articular rheumatism. 

Tincture is the best form. Dose, two drops ; never more than 
ten drops to be given in a day — a very small quantity will destroy 
life. 

VERATRUM AND VERATRIA. 

Veratria is the poisonous principle found in colchicum and other 
plants. It is a white, very acrid, inodorous substance, scarcely sol- 
uble in water, and not very soluble even in boiling water. It is 
quite soluble in alcohol, ether, and the vegetable acids. It is not 
a safe domestic remedy for internal use. It may be employed exter- 
nally, and chiefly in the relief of rheumatic and other chronic pains, 
rubbed into the parts in the form of an ointment, being mixed with 
hog's-lard. From ten to twenty grains of veratria, mixed with an 



CIM1CIFUGA.— C0LCHICUM. 421 

ounce of liog's-lard, is the safe proportion — about the size of a large 
nutmeg being rubbed into the part night and morning. The proof 
of its taking effect is the sensation of sharp pricking which is 
usually felt on the part subject to its operation. After it has been 
used for three or four days, it will sometimes occasion sickness 
and vomiting. 

Tincture of veratrum is made from the veratrum, viride — a plant 
of which veratria is the active principle. It is a most powerful sed- 
ative. The dose is from two to four drops of Norwood's tincture. 
From its power over the action of the heart, it has great power in 
controlling the severe forms of inflammation. 



CIMICIFUGA {Black Snakeroot— Cohosh). 

This is a native plant, abundant in various parts of the country, 
the virtues of which are extracted by boiling water. It is used 
with great success by the country people, and by the doctors, as a 
remedy for acute rheumatism, and for the nervous diseases allied to 
rheumatism, as chorea. Of the saturated tincture, made with four 
ounces of the root to a pint of alcohol, give in acute rheumatism 
twenty to forty drops every two hours. Boil an ounce of the root 
in a pint of water and give a wineglassful three times a day in 
chorea. 

COLCHICUM. 

This is the meadow-saffron, and is a perennial plant, generally 
found growing in moist, rich meadow-grounds, and flowering in 
September. 

Its action is that of a purgative, diuretic, and sedative, or nar- 
cotic. Hence it stimulates the excretory ducts of the liver and 
pancreas, and the mucous membrane of the intestines, producing 
copious bilious stools, and diminishing febrile action; but it is a 
violent medicine, often dreadfully depressing, and therefore unfit for 
domestic use. It has been chiefly used in gout and rheumatism ; 
but, in order to its being of much permanent benefit in these mala- 
dies, it requires to be administered with caution and judgment, or 
otherwise it will prove detrimental instead of being useful. In gout 
and rheumatism, its powers, when directed and regulated by a judi- 
cious mind, are often valuable as an anodyne, since it allays the 
tormenting pain of those cruel disorders more speedily and effectu- 
ally than any other remedy, and, in combination with other suitable 
medicines, may shorten the period of the disease. Given persist- 
ently in attacks of gout, it at first controls and subdues all the 



422 MATERIA MEDIO A. 

symptoms, but soon loses all power and has no effect on the disease, 
while the intervals between paroxysms become shorter during its 
employment. It operates on the bowels chiefly, and the nerves; 
and, when taken in excess, it enervates the digestive organs, and 
has a terrible effect of a depressing nature on the whole nervous 
system, which is apt to remain for some time. 

The dose of the extract is from half a grain to one grain. The 
vinegar (acetum colchici ) is the best mode of administering it ; but 
the tincture may also be given in the dose of fifteen drops, com- 
bined with a little magnesia and water. 

VALERIAN 

Valerian is antispasmodic and tonic ; and is sometimes highly 
beneficial in those diseases which appear to be connected with a 
morbid susceptibility of the nervous system, as in hysterics, pain of 
one side of the head, and in some species of epilepsy. It is of ser- 
vice in some instances of hypochondriasis, or low spirits, but its very 
nauseous taste. is a great obstacle to its frequent employment. It is 
best given in substance, united with a small portion of mace or cin- 
namon, which in some degree disguises the flavor. The dose is from 
a scruple to a drachm, given three or four times a day. 

The ammoniated tincture of valerian is an efficacious cordial and 
antispasmodic, of great benefit to the nervous and low-spirited. 
The dose is from one to two or three teaspoonfuls, with a teaspoon- 
ful of tincture of cinnamon, thrice a day, in water ; but it should 
not be given in any bitter infusion. 

MUSK. 

This article is stimulant, and antispasmodic, possessing much 
power in resolving spasm, and increasing the energy of the brain 
and nerves. Hence it is sometimes efficaciously given in typhus 
fever, when low delirium, twitching of the tendons, and hiccough, 
supervene. It has also been praised for its virtues in arresting the 
progress of gangrene, when combined with ammonia. It is some- 
times advantageously exhibited in spasmodic diseases, especially in 
epilepsy, hysterics, and cholera morbus. In large doses it is of great 
service when gout suddenly leaves the extremities, and fixes on the 
stomach, or some other vital organ. It is a very high-priced article, 
and is with great difficulty obtained genuine. 

It is given in substance, in the form of a bolus, of which the 
dose may be from eight grains to a drachm, repeated at intervals of 
three and six hours. 



ASSA FCETIDA.— CASTOR.— AL UM.—NUTGALLS. 423 

ASSAFOETIDA. 

This article is a gum resin, obtained from the roots of a tree 
which is a native of the south of Persia. It is brought into this 
country packed in cases, mats, and casks. The best is clear, and of 
a pale-reddish color, contains many of the white tears, and has the 
odor very strong. 

It is powerfully antispasmodic, and expectorant, and is given 
with advantage in hysterics, low spirits, flatulent colic, and. in the 
coughs of the aged and the nervous. The dose is from five grains 
to a scruple ; it is best taken in the form of pills, on account of its 
nauseous taste. In hysterics a drachm of assafcetida may be mixed 
with an ounce and a half of peppermint-water, two drachms of am- 
moniated tincture of valerian, and two drachms of sulphuric ether, 
of which mixture the dose is a tablespoonful every second hour. 
When given in a clyster for the cure of flatulent colic, it often oper- 
ates like a charm. 

CASTOR. 

This is an oily substance secreted by the beaver in a bag near 
the rectum ; it is a nervous stimulant, antispasmodic and emmen- 
agogue, and is useful in several nervous affections, especially when 
connected with uterine irregularity ; that from Russia is much the 
best. Dose of the powder, from ten to twenty grains ; of the tinc- 
ture, from one to two drachms. Chemists have extracted its active 
principle, which they have called castorine, but it has not come 
much into use. 

ALUM. 

This is a triple salt, the sulphate of alumina and potassa. It is 
one of the most powerful astringents. Taken inwardly it causes 
some uneasiness to the stomach. It constipates the bowels, unless 
large doses are given, when it purges. It is in a certain degree 
stimulant also. It is mildly caustic, and is the best application to 
exuberant granulation on sores. It is a useful application in uter- 
ine or other haemorrhages, and makes an efficient gargle for relaxed 
states of the throat. 

NUTGALLS. 

Nutgalls are a very powerful astringent ; and the infusion, pre- 
pared by pouring six ounces of water upon four drachms of nut- 
galls, is a very useful injection in whites and gleet. It forms also an 
28 



424 MATERIA MEDIC A. 

excellent astringent gargle in relaxation of the uvula, and is undoubt- 
edly of great service as an astringent in prolapsus of the anus and 
womb. Gallic acid is one of the most efficacious remedies in bleeding 
from the bladder, and other parts, in doses of five grains in mucilage 
of gum-arabic, repeated as occasion may require. 



CATECHU 

Has tonic and astringent properties, which render it valuable in 
diarrhoea, chronic ' dysentery, and passive haemorrhages, especially 
those of the bowels or uterus; also in leucorrhoea, gleet, chronic 
catarrh, and all cases of increased mucous discharge without inflam- 
mation. In the composition of astringent gargles and lotions for 
ulcered sore throat, ulceration of the mouth, chapped nipples, etc., 
it is employed with advantage : for the last-named purpose the tinct- 
ure is generally used ; of this, the dose is from half a drachm to two 
drachms ; of the infusion, from one to two ounces ; of the powder 
from ten to thirty grains ; of the electuary, from one to six scruples. 
There is also a catechu-lozenge, of which one may be taken several 
times a day for hoarseness ; and a compound powder, the dose of 
which is from one half to one and one half drachm : mixed with 
bark and myrrh, it makes a good dentifrice. Catechu was for- 
merly called terra japonica, or Japan earth ; it was then sup- 
posed to be a mineral instead of a vegetable production ; the best 
kind is of a pale chocolate color ; it should be free from sticks and 
other impurities. 

MATICO. 

This is used in chronic dysentery and diarrhoea, in the form of 
infusion of the leaves, the under side of which, or the powder, applied 
to obstinate leech-bites, cuts, or bleeding surfaces, will, it is said, 
arrest the flow of blood. The tincture, mixed with water, forms a 
good astringent lotion for the mouth. The dose of the powder is 
from ten to thirty grains ; of the infusion, prepared by pouring a pint 
of boiling water on one ounce of bruised leaves, one ounce ; it may 
be taken three or four times a day. The tincture is made with two 
ounces of bruised leaves to a pint of proof spirit ; the dose of this is 
from one to two drachms. 

TANNIN. 

A principle obtained from oak-bark, and other astringent vege- 
tables, and so called from its forming the principal agent in the 
nrocess of tanning. Tannic acid is prepared from galls treated with 



KINO.— CREOSOTE. 425 

sulphuric ether ; it makes a good astringent gargle or injection in 
the proportion of from five to eight grains to one ounce of distilled 
water ; it is sometimes given in internal haemorrhage, and also in 
diarrhoea ; dose, from one to two grains, dissolved in water or in a 
pill ; it is precisely similar in its action to gallic acid. 

KINO. 

This is, perhaps, the most powerful of all the vegetable astrin- 
gents, containing about seventy per cent, of tannic acid ; hence its 
use in diarrhoea, dysentery, gonorrhoea, leucorrhoea, and internal 
bleedings and discharges generally. It is also employed as an ex- 
ternal application to foul ulcers, as a gargle to constringe relaxed 
uvulae, and as a styptic. The dose of the powder is from one to two 
drachms ; of the compound powder (which contains one grain of 
opium to twenty grains of kino), from ten to twenty grains ; of the 
tincture, from one to two drachms. 

CREOSOTE. 

In its pure state it is a colorless, transparent, oily liquid, having 
the fluidity of thin almond-oil. One of its most remarkable prop- 
erties is the decisive power with which it is endowed of effecting 
the rapid coagulation of all the albuminous and serous fluids ex- 
isting in the living as well as the dead animal tissues. When 
brought in contact with white of egg, coagulation instantly ensues. 
Creosote, in its concentrated state, and in consequence probably of 
its coagulating power, exerts all the decisive and rapid .effects of a 
strong poison on man and animals ; small animals, as wasps, beetles, 
etc., when moistened with it, dying under long and violent convul- 
sions, and fish ceasing to exist in water impregnated with one-hun- 
dreth part of it. 

Where two or three drops of very dilute creosote are taken into 
the stomach, a sensation of warmth is experienced. The greatest 
circumspection is required in the administration of this medicine. 
Internally administered, it is chiefly useful in a few peculiar cases 
of indigestion, where a good deal of torpor exists ; externally it is 
used with uncommon advantage in ringworm of the scalp, in itch, 
and in toothache. In toothache from decayed teeth, it is only ne- 
cessary to moisten the point of a wooden spill with the creosote, 
and introduce it into the hollow of the tooth. 

The creosote mixture, in which the taste is concealed by oil of 
juniper, is the best form of administration ; the dose is from one 
to two ounces. We give the form : creosote and acetic acid, of each, 



426 MATERIA MEDIC A. 

sixteen minims ; compound spirit of juniper and syrup, of each, one 
ounce; water, fourteen ounces; mix the creosote with the acid, 
then add the water gradually, and lastly the syrup and spirit. As 
a lotion for inflamed eyelids, and mercurial salivation, a preventive 
of bed-sores, and a variety of other purposes, this substance has 
been applied successfully. 

KRAMERIA {Rhatany). 

This is a powerful astringent and tonic, and may be used as such 
in most diseases of debility and relaxation. It has been long known 
to the manufacturers of port-wine, who use it to impart the astrin- 
gency which that wine always contains. It is particularly useful 
in some cases of chronic diarrhoea and dysentery. It is most fre- 
quently administered in infusion, decoction, or extract. The infu- 
sion is made with half an ounce of the bruised root to six ounces of 
boiling water, poured on it ; of which the dose is from one to two 
ounces. The decoction is made by boiling two ounces of the 
bruised root in a pint of distilled water ; the dose is the same as of 
the infusion. A teaspoonful or two of the tincture in water, two 
or three times a day, is a convenient mode of taking it, and also an 
efficacious one. This medicine is given in Bright's disease, and re- 
duces the quantity of albumen lost in the urine. It also remedies 
that condition of the intestine which leads to fistulae. 



LEAD. 

Preparations of lead are used medicinally as astringents, both ex- 
ternally and internally, and are also given as antispasmodics and seda- 
tives ; to check hsematopsies and other forms of bleeding they are 
administered, as well as in fluxes of the bowels and urino-genital or- 
gans ; and their application in the form of lotions, ointments, and plas- 
ters, to inflamed surfaces, is commonly of great service. It should 
be borne in mind that these preparations are very poisonous, and 
therefore unfit for internal use, except under medical advice. 

Acetate of lead (JPlumbi acetas) is the form generally adopted 
for internal use ; it is given in hsematemesis, diarrhoea, and dysen- 
tery, in doses of from three to five grains ; it also forms astringent 
lotions, injections, and ointments. 

Diacetate of lead (P. diacetas) is the sugar of lead ; in strong 
solution it constitutes Goulard's extract ; in weaker, Goulard water ; 
cooling and astringent lotions for inflamed parts, collyria for various 
ophthalmic affections, and injections for gonorrhoea and leucorrhcea 
are made from these. 



MALE FERN.— PINK-ROOT.— SALT. 427 

Carbonate of lead (P. carbonas), generally known as white lead. 
The powder is mixed with lard, to form a cooling ointment, and is 
used dry as an absorbent and astringent. 



MALE FERN. 

A co mm on plant, chieny used as a remedy against tape-worm. 
Oil of male fern is the most satisfactory preparation, but powder of 
the root is also used. 

The dose of this powder is from one to three drachms ; it should 
be given on an empty stomach, and followed, in the course of two 
or three hours, by an aperient ; castor-oil is the best. The oil of 
male fern is obtained by evaporating an ethereal tincture of the 
buds or roots, and this is the pleasantest and most convenient 
form of administration. It may be taken thus : one-half a drachm 
mixed with two ounces of mucilage, half at bedtime, the rest in 
the morning, with an ounce of castor-oil three or four hours after 
the second dose. A decoction of the fresh root or buds is also ef- 
fectual : dose about four ounces ; of the ethereal tincture, from one to 
two drachms may be given ; and of the extract from ten to thirty 
grains. 

PINK-ROOT {Spigelia marilandicd). 

This is one of the most powerful anthelmintics known ; it be- 
longs to the natural order jSpigeliacew, so called from Adrian Spige- 
lius, of Padua, who first discovered the properties of the plants 
composing this order. This plant is also a puragtive, and to some 
extent a narcotic ; the root, which is the part used, has a faint odor, 
and a peculiar and unpleasant taste. When given for worms it 
should be followed by a brisk cathartic ; the dose is from ten to 
twenty grains for a child ; from one to two drachms for an adult, 
repeated morning and evening for some days. 



SALT. 

This term is applicable to saline matter generally ; but in its 
common application we understand it to mean the chloride of sodi- 
um, or common table-salt, which, as a condiment, and used in mod- 
eration, is beneficial to man, who, in common with the lower ani- 
mals, appears to have an instinctive desire for it. There can be no 
doubt that salt greatly assists the process of digestion ; it is one of 
the constituents of the blood, and of the body generally, and we 
find that, where it is denied, the digestive powers are weakened, 



428 MATERIA MEDIC A. 

and the general tone of the system is impaired. It has also "been 
observed that those who do not take salt are especially liable to 
worms in the intestines. Hence the desirability, if not the necessi 
ty, of insisting that children should eat a certain proportion with 
their food. On the other hand, if taken in excess, it is productive 
of mischievous results as a cause of scurvy. As a medicinal agent, 
salt occupies an important place; in some cases of convalescence 
we find an intense craving for it ; and this should be indulged, but 
not to an immoderate extent, as it appears to have a tonic effect. 
It is sometimes administered as a domestic emetic in solution — two 
ounces being dissolved in half a pint of warm water ; occasionally, 
however, when so administered, it acts as a powerful purgative. 
Such a solution, thrown up as a clyster, destroys and brings away 
worms from the large bowels. Some advocate the use of salt in 
the treatment of typhus fever and cholera, and some have even held 
it up as a panacea, or universal remedy ; while there are not want- 
ing those who attribute to its use nearly all the ailments to which 
man is liable. 

As an external application it exerts a tonic influence, and is 
highly beneficial in cases of debility, whether local or general. 
The salt-water bath braces and stimulates the system, and warm sa- 
line bathing and rubbing are good for rheumatic affections, sprains, 
etc. ; if prepared artificially, about a pound of salt to three gallons 
of water is a proper average strength. " Brandy and salt " is an 
excellent stimulant application. 

With regard to the preservative properties of salt on animal 
substances, we may observe that the chemical change which it ef- 
fects in the juices of the meat, to which it is applied, considerably 
modifies the nutritive properties, and renders it less fit to nourish and 
sustain life ; hence fresh meat is better than that which is preserved 
by salting, which should never be taken as a staple article of diet, 
if it can be avoided. 

KOUSSO. 

This medicine consists of the flowers and unripe seeds of the 
Bray era anthelmintica, an Abyssinian plant. It is especially lauded 
as a remedy against the tape-worm. 

The dose of kousso for an adult is half an ounce, reduced to a 
fine powder, and infused for a quarter of an hour in a pint of boiling 
water ; the whole to be well stirred together and drank early in the 
morning on an empty stomach. The mixture is almost tasteless, 
and consequently does not require any addition for the purpose of 
making it palatable ; but the Abyssinian method of mixing honey 



TURPENTINE. 429 

with it is a good practice. The French physicians give a dose of 
castor-oil twenty-four hours before exhibiting the kousso, but this is 
not necessary. It is advisable that the bowels should be in an 
empty state when it is taken, but not relaxed ; therefore a small 
quantity only of simple food should be taken, both before and after 
the dose, for twenty-four hours. 

The immediate result of the medicine is generally two or more 
evacuations of the bowels during the day ; these should be carefully 
examined, to ascertain if the whole of the worm is expelled, and the 
head of the animal should be particularly sought for, if possible, by 
the aid of a microscope. Should it not be found, or should the bow- 
els not act sufficiently within twenty-four hours, a dose of castor-oil 
must be given, and the same attention directed to the evacuations. 
It is said to be very seldom that a second dose of the kousso is re- 
quired, and some little time should be allowed for the action of the 
first dose, before it is resorted to ; it may, when necessary, be re- 
peated with perfect safety. 

The effect of kousso upon the worm appears to be very severe 
and distinctive. When discharged it is generally found completely 
saturated, as it were, with the powdered kousso ; its joints are filled 
with it, its various mouths choked up by it ; and it is even found to 
have penetrated the alimentary canal. 



TUEPENTIXE. 

The oil of turpentine, as it is commonly called, is procured by dis- 
tillation from the resinous exudations of many trees of the pine 
tribe, but especially from the Pinus palustris. 

The action of turpentine on the system is anthelmintic, diapho- 
retic, diuretic, purgative, and stimulant ; it is also given as an as- 
tringent : externally it acts as a rubefacient. As an anthelmintic it 
should be given in combination with castor-oil, lest, failing to 
purge, it should stimulate the urinary organs too much, and pro- 
duce dysuria ; as a diuretic, it is prescribed in dropsy and suppres- 
sion of urine ; as a purgative, it is useful in cases of tympanitic dis- 
tention of the abdomen, and in acute stages of puerperal fever ; as a 
stimulant to the nervous system, in neuralgia and epilepsy ; as an 
astringent, in internal haemorrhages, and to check the mucous dis- 
charge in gonorrhoea and leucorrhcea. Guthrie and others have pre- 
scribed it in inflammation of the eye. The ordinary dose, as a stimu- 
lant and diuretic, is from ten to thirty minims ; as a cathartic or 
vermifuge, half an ounce to two ounces, with castor-oil : the best 
mode of administration is to suspend it in mucilage or yolk of egg. 



430 MATERIA MEDIO A. 

Canada balsam, Chio or Cyprus turpentine, common or stone 
turpentine, Strasburg turpentine, and Venice turpentine, are all the 
products of different species of pines, which belong to the natural 
order Coniferce ; they differ but little in their medical properties. 



PUMPKIN-SEEDS. 

The seeds of the common pumpkin are the most certain cure for 
tape-worm. Take an ounce of the seeds, macerate in hot water so 
as to get rid of the hard, cortical part, powder, and take in the 
same manner as directed for kousso. 



SANTONIN. 

This is the alkaline principle of the Jerusalem worm-seed, and is 
the most effective of all medicines against the round worm. It is 
tasteless, and requires but a small dose ; hence it is the best medi- 
cine for children. Never give a child of two or three years more 
than a grain at a dose. 

COLD. 

The use of cold, in the treatment of disease, has long been known 
and highly valued. On the system generally it acts as a bracing 
tonic, strengthening and invigorating the frame. In certain forms 
of inflammatory disease, and where there is undue excitability of 
any organ, the application of cold is attended with the most benefi- 
cial effects. That of ice is generally applied, when the ice itself can 
be procured, but a very low temperature may be produced by vari- 
ous evaporating lotions made with spirits, etc., and other constitu- 
ents : one of the most useful and easily procured is a compound of 
muriate of ammonia, commonly called sal-ammoniac, and nitrate of 
potash, or saltpetre, of each of these one-half an ounce added to a 
quart of water fresh from the spring or well, should the weather be 
warm. The best spirit to use is ether, next to that pure alcohol, 
but any strong spirit will produce the effect ; moisten a piece of 
lint with it, and lay it over the part affected. 



DALBY'S CAKMINATIVE. 

Dr. Paris gives, as a formula for the preparation of this cele- 
brated quack medicine, the following : 



ARNICA. 431 

Carbonate of magnesia, 2 scruples. 

Oil of peppermint, 2 drops. 

" nutmeg 2 drops. 

" aniseed, 3 drops. 

Tincture of castor, 30 drops. 

" assafoetida, 15 drops. 

" opium, 5 drops. 

" cardamoms (compound) 30 drops. 

Spirit of pennyroyal, 15 drops. 

Peppermint-water, 2 ounces. 

The great objection to the use of this otherwise excellent carmi- 
native is the opium which it contains ; for this is a drug which should 
never be given to the young, unless under medical sanction and 
supervision. The above formula contains, we see, five drops to two 
ounces ; but every druggist makes his own " Dalby " according to 
his own particular form ; and in many of the formulas there is no 
doubt a much larger proportion of the objectionable drug ; indeed, 
the stronger he makes it in this respect the greater satisfaction will 
be given to his customers, whose object is to "still" their fretful in- 
fants. Leave out the laudanum, and no better carminative could 
be administered than the above ; leave it in, and " Dalby's " is a 
dangerous nostrum, whose frequent and habitual use, although it 
saves mothers present trouble, entails upon them future sorrow and 
anxiety, by making their children grow up puny and sickly, if it 
does not produce mental imbecility. 

[The "Dalby of the Period" is called "Mrs. Winslow's Sooth- 
ing Syrup."] 

ARNICA. 

Commonly called leopard's-bane. Botanical name, Arnica mon- 
tana ; natural order, Asteraceaz. Many virtues have been ascribed 
to this plant — more, perhaps, than it really possesses ; its principal 
appears to be that of a nervous stimulant. On the stomach and 
bowels it acts as an irritant ; it is said also to be diuretic, diapho- 
retic, and emmenagogue. In Germany it is a popular remedy for the 
ill effects of severe falls, bruises, etc., on the nerves and brain; it is 
also given in amaurosis, paralysis, and other nervous affections ; 
also hydrocephalus, and typhus fever, in the latter stages of which 
it has been recommended. It is used externally in lotions for bruises 
and affections of the brain. Dose of the powdered flowers, five to 
fifteen grains ; powdered root, ten to thirty grains ; infusion, half 
an ounce ; extract, one to ten grains ; tincture, thirty drops ; essen- 
tial oil, one to two drops. 



432 MATERIA MEDIC A. 



POPPY. 



The poppy-heads used for fomentations are mostly of home 
growth ; their anodyne properties render them valuable for soothing 
fomentations, for which purpose they should be broken up and 
boiled, the liquor only being used ; into this, when quite hot, a flan- 
nel should be dipped and wrung out, and then laid on the part af- 
fected, dipping it afresh as soon as it begins to cool : for this pur- 
pose the seeds need not be used, as they possess no medical virtues ; 
they contain an oil useful in the arts, which is obtained by expres- 
sion. 

Extract of poppies is made by boiling down fifteen ounces of 
bruised poppy-heads in one gallon of water, until it is reduced to 
four pints ; strain the liquor, and evaporate to a proper consistence ; 
it is not so strong as opium, and may be given in doses of from two 
to ten grains, as an anodyne. 

Syrup of poppies is thus prepared : poppy-heads, bruised, three 
pounds, put into five gallons of water, boil down to two gallons ; 
strain, and again boil to four pints ; strain, and set aside to cool, 
and allow the dregs to subside : again boil to two pints ; and in this 
dissolve five pounds of lump sugar, pour into a vessel to cool, and 
add spirits of wine five fluidounces; this forms an ingredient in 
many cough mixtures, and is often given to children to soothe them 
when fretful, a most reprehensible practice ; the dose for an adult is 
from two to four drops. 

Syrup of red poppies (Syrupus rhoeados) is made by pouring 
on a pound of poppy-leaves one pint of boiling water; let it macer- 
ate for twelve hours, then strain, and add three pounds of sugar ; 
boil until well dissolved, then add spirits of wine two and one-half 
fluidounces ; it is questionable whether there is much medical vir- 
tue in this ; it is chiefly used as a coloring material. 



GODFREY'S CORDIAL. 

This is the common "sleeping-stuff" which the poorer classes 
give to their children to keep them quiet, while the parents are out 
working or taking their pleasure : its extensive and indiscriminate 
use is the cause of much mischief; the objections which we have 
urged against Dalby's carminative apply with much greater force 
to this compound. " Godfrey's " is prepared in various ways, but 
the following formula will pretty fairly represent what are its gen- 
eral constituent principles: boil in eight gallons of water one 
pound each of caraway, coriander, and anise seed, with two ounces of 



OX- GALL.— GREG OR TS PO WDER.— GL YCERINE.—B ORAX. 433 

ginger ; while hot, mix fourteen pounds of treacle ; and, when a 
little cool, two pints of laudanum, in which two ounces of oil of sas- 
safras have been previously put. Let the whole stand, frequently 
shaking, for two or three weeks, then strain and make up to eight 
gallons with water. Were it not for the quantity of opium which it 
contains, this would be a very good carminative ; and, as it is, may 
be a serviceable medicine, properly and discreetly used. 

OX-GALL. 

Some years ago the gall or bile of the ox was quite a fashion- 
able remedy for habitual constipation ; in many cases it was un- 
doubtedly found serviceable, but not perhaps in the majority, and 
it therefore fell very much into disuse. Where there is a want of 
tone in the stomach, and especially with pregnant women, it often 
acts extremely well ; it may be prepared for medicinal purposes in 
the following manner : buy a gall-bladder and turn out the contents 
in a shallow vessel, of metal is best ; put it in an oven and let it 
evaporate until it becomes sufficiently firm to make into pills, of 
which one or two, of five grains each, may be taken twice a day. 

GREGORY'S POWDER, 

So called from Dr. Gregory, who first used it, consists of rhubarb, 
calcined magnesia, and ginger, in the proportion of two parts of the 
first, four of the second, and one of the third. It is an excellent 
stomachic and mild aperient, and may be taken occasionally by 
both adults and children with great advantage ; but it should not 
be taken often and regularly, as the quantity of magnesia will be 
likely to irritate the coats of the stomach, and bring on diarrhoea 
and dysentery. Gregory's powder may be taken either in simple 
water, or with a few drops of sal-volatile, which will increase its 
stimulant and tonic properties. 

GLYCERINE 

Is the sweet principle of oils produced during the making of 
soaps. It has been recommended internally in consumption. It is 
usefully employed as an external application iu scaly diseases of 
the skin, and to ulcers, and it has been recommended in deafness. 

BORAX. 

This is a bi-b orate of soda. The natural salt is found chiefly 
in Persia and Thibet. The preparation commonly in use is the 



4:34: MATERIA MEDIC A. 

honey of borax. This is a cooling, cleansing application to the 
tongue and fauces in thrush. Dissolved in water, in any agreeable 
proportion, it proves an excellent gargle in those affections. 



BROMIDE OF POTASSIUM. 

This is a very powerful sedative, that directly controls morbid 
irritability of the brain and nervous system. It may be given to 
procure sleep, to lessen cerebral excitement, and to control spasm 
and convulsions. Give ten, twenty, or thirty grains in water at a 
dose, and repeat every hour or every second hour. 



PAREGORIC ELIXIR. 

This is made by mixing together two scruples of camphor, one 
drachm of hard opium in powder, one drachm of acid of benzoin, 
and two pints of proof spirit ; which are allowed to digest for four- 
teen days, and afterward filtered. 

It is advantageously employed to allay irritation and procure 
rest in habitual cough, chronic asthma, and the latter periods of 
hooping-cough. It is most appropriate in dry coughs. It may also 
be employed with effect, for the same purposes, in recent cold and 
cough, after the inflammatory symptoms have abated; but it is 
highly improper in all cases of cough attended with much fever, 
pain in the chest, and full, quick pulse. Half a fluidounce of this 
elixir contains nearly a grain of opium. The dose to procure ease 
in cough is from one to two teaspoonfuls occasionally ; and three 
teaspoonfuls where quiet, rather than sleep, is required. 



ICELAND-MOSS. 

Iceland-moss, called also Iceland-liverwort, is tonic and demul- 
cent. It unites a strong bitter principle with demulcent properties, 
on which its medicinal effects are supposed to depend. It is gen- 
erally given in the form of decoction, which is prepared by boiling 
one ounce of the picked moss in a quart of water down to a pint, 
and then straining it while hot. The dose is from half an ounce to 
two ounces, three times a day, either alone or mixed with milk. In 
this state the decoction is very bitter, but, although not the most 
pleasant, it is probably the most efficacious way in which it can be 
taken. If, however, the patient will not take it in this way, it may 
be freed from a considerable portion of its bitterness by being 
steeped in hot water for two or three hours, previous to its being 



GUM-ARABIC— LIQUORICE.— FLAXSEED. 435 

used to make the decoction. This water, is of course, thrown away, 
and then the ounce of moss is boiled in two pints of water, as above 
directed 



GUM-ARABIC. 

The tree which yields this article is found in almost every part 
of Africa. This gum is a simple demulcent, serving to lubricate 
abraded surfaces, and involve acrid matters in the stomach and 
bowels. It is chiefly used in the state of mucilage, but is sometimes 
taken in the solid form, to sheath the fauces, and allay the tickling 
irritation which occasions the cough in catarrh and pulmonary con- 
sumption ; in which cases, a piece of it is allowed to dissolve slowly 
in the mouth. 

The mucilage of gum-arabic is made by dissolving four ounces 
of gum-arabic, in powder, in half a pint of boiling water. This, in 
the dose of half an ounce or an ounce, is a useful demulcent in loose- 
ness, dysentery, gravel, and scalding of urine, or as a vehicle for 
opium, and other medicines, in these complaints. 

Gum-water, made by pouring a pint of boiling water on two or 
three ounces of gum-arabic, is a very useful and agreeable diluent 
in many disorders, both acute and chronic. Thus in fever, in cough, 
consumption, stomach, and other chronic complaints, it cools the 
mouth, and sheaths the throat and alimentary canal, and likewise 
affords some support. 

LIQUORICE. 

This is an inspissated vegetable juice, whose demulcent proper- 
ties render it very useful in coughs and bronchial irritations ; it 
may be taken in considerable quantities without disordering the 
stomach, or causing thirst. This extract is often used to cover the 
taste of more nauseous medicines. Good Spanish juice is hard and 
brittle, breaking short off when struck ; it enters into the composi- 
tion of many kinds of lozenges. A soft extract of liquorice is used 
by druggists in the composition of pills, and the powdered root is 
also much employed. 

FLAXSEED. 

The " tea " so-called, which is a decoction of the seeds, is a very 
excellent demulcent for use in colds, and all the occasions where 
such an article is necessary. The poultice made of flaxseed meal is 
exceedingly soothing, by reason, of its soft, "emollient quality. 



436 MATERIA MEDIC A. 



HYDROCHLORIC ACID. 



This acid is tonic and antiseptic, and is efficaciously used in 
typhus and typhoid fevers, malignant sore throat, and cutaneous 
eruptions. The good effects of this acid in malignant typhus fever 
are sometimes remarkable. 

The dose is from ten to twenty drops, in a teacupful of barley- 
water, or infusion of bark. In desperate cases of typhus, half a 
drachm may be given at a dose, every four hours, properly diluted. 

It is likewise useful in some cases of indigestion accompanied 
with general debility, in the secondary symptoms of syphilis, and in 
white gravel. It is a powerful escharotic, and is used to cauterize 
the pharynx in diphtheria or other throat-diseases. 

In the proportion of a drachm or two, in six or eight ounces of 
infusion of roses or decoction of bark, it forms a very useful gargle 
in ulcerated sore-throat. 

By pouring a little sulphuric acid on common salt, muriatic acid 
gas is disengaged, which has the important property of destroying 
the infection in sick-rooms and hospitals, where putrid fever exists. 

When this acid is taken as a poison, the best antidotes are soap 
and calcined magnesia, suspended in water, the patient taking care 
to drink copiously of warm water, milk, or broth. 



NITRIC ACID. 

This is prepared from the nitrate of potash, or saltpetre and 
sulphuric acid. A heavy, colorless fluid; has tonic, antiseptic, and 
antisyphilitic properties ; it is given in chronic disease of the liver 
and indigestion, especially when connected with urinary deposit of 
uric acid, and the phosphates. On scrofulous habits, and constitu- 
tions worn out by indulgence in excesses, it sometimes has a good 
effect ; it has also been found useful in whooping-cough and asthma. 
It is usually prescribed in the diluted form of one part to nine parts 
of water, the dose of which is from ten to twenty drops. Largely 
diluted, it is given as a drink in fevers of the typhoid kind, in dys- 
pepsia, and cases where there is a redundancy of bile. 



SULPHURIC ACID, OR OIL OF VITRIOL. 

Prepared from sulphur. This is the most ponderous of all the 
fluids, except quicksilver, being more than double the weight of 
water ; when pure it is perfectly clear and white, but so great is its 
dissolving power that the slightest portion of vegetable or animal 



CITRIC, GALLIC, AND OXALIC ACIDS. 437 

matter which it may take up speedily deepens the color, and event- 
ually turns it nearly black. This is the strongest and most corro- 
sive of acids, and one of the most powerful of mineral poisons ; and 
yet, largely diluted, it is very commonly administered as an antisep- 
tic and refrigerant in typhoid fevers, as a tonic in general debility, 
and as an astringent in haemorrhages and excessive perspiration. In 
chronic cutaneous affections, where there is troublesome itching, it 
is also given with good effect ; and latterly it has been much used, 
and with remarkable success, in the epidemic diarrhoea, often pre- 
monitory of cholera, which has, from time to time, prevailed in this 
and other countries. The diluted sulphuric acid of the pharmaco- 
poeia, which is usually prescribed, contains one and one half in 
twenty parts, and the dose of this is from ten to thirty minims 
largely diluted. For a gargle to check salivation, one to three 
drachms may be put into half a pint of any convenient fluid ; this 
may be used in all cases where an astringent application is required. 

CITRIC ACID. 

This is prepared from lemon-juice. It is in white, semi-transpar- 
ent crystals of a rhomboidal shape, soluble in twice their weight of 
cold, and half their weight of boiling water. This acid is refriger- 
ant, antiphlogistic, and antiseptic in its effects. It is useful in fevers 
and inflammatory complaints ; combined with carbonate of soda, it 
forms a good effervescing draught ; dissolved in water, in the pro- 
portion of one drachm to a quart, may be employed as a substi- 
tute for lemon juice. The usual dose is from ten grains to a scruple ; 
fifteen grains of it, neutralizes twenty grains of bicarbonate of soda. 

GALLIC ACID 

Is obtained from galls, and, like them, is powerfully astringent ; 
given to stop inward bleedings and other discharges, and used in 
gargles, lotions, and injections. Dose — from two to ten grains, as a 
general tonic and peptic. In chylous urine, it has been given in 
twenty-grain doses three times a-day. It is in brownish-white 
crystals, semi-transparent, weighs light, and dissolves in spirit of 
wine or hot water. 

OXALIC ACID. 

This acid is found in the state of oxalate of lime, in the roots of 
several plants; and in the state of binoxalate of potash, in the 
leaves of the Oxalis acetosella and some species of rumex. Its salts 
are called oxalates. The essential salts of lemons, or salt of sorrel, 



438 MATERIA MEDIC A. 

is the binoxalate of potash, and the oxalate of lime is the basis of 
the mulberry calculus. As poisoning by oxalic acid is not of un- 
frequent occurrence, in consequence of its close resemblance to Ep- 
som salts, a few simple directions for such an emergency had better 
be given here. When a large dose of the poison has been swallowed, 
the first and almost immediate effect is complete prostration of 
strength ; the patient sinks at once into a state of collapse, and dies 
within half an hour after taking the poison ; severe pain at the 
stomach and vomiting sometimes precede this state of stupor, but 
not always. When there is vomiting, the expelled matter is very 
acid and dark in color. In such a case, only the most prompt 
measures can be of any service ; the knowledge that oxalic acid (in 
itself readily soluble) forms, in combination with lime and magnesia, 
insoluble and comparatively inert compounds, teaches us that chalk 
or whitening is the best remedy ; and, happily, one or other of these 
substances is generally at hand ; if not, some old mortar scraped 
from the crevices of a wall may be mixed up with water and swal- 
lowed. Vomiting should be by all means excited, and plenty of 
water given to dilute the poison, and favor its rejection from the 
stomach. In the collapsed stage, stimulants will be required- 
brandy is the best ; should the patient survive, there is likely to be 
great irritability of the stomach for some time ; for this, soothing 
demulcent drinks and a milk diet should be given, and a few leeches 
may be applied to the pit of the stomach. 



CARBONIC ACID. 

This is the gas which, when introduced into the stomach in 
effervescing draughts, is so invigorating and refreshing, and which, 
when inhaled in large quantities, as in the case of wells and other 
confined places, is so prejudicial to life. In the former case, it is re- 
frigerant and antiseptic, checking vomiting, and allaying thirst and 
gastric irritations. Applied to the skin, it acts as a stimulant, and 
it is useful to promote suppuration in ulcers, and remove the un- 
pleasant fetor which attends a purulent discharge. It has been 
used as an injection into the rectum for cancerous ulcers and dys- 
entery, and also into the uterus for a diseased condition of that 
organ. Carbonic acid is an active ingredient in several officinal 
compounds. 

VINEGAR. 

Vinegar is a weak vegetable acid, produced by exciting the 
acetous fermentation in substances which have undergone, or are 



VINEGAR. 439 

Busceptible of, the vinous fermentation. Sugar and water, the sac- 
charine vegetable juices, infusions of malt, malt liquors, cider, and 
wine, may be converted into vinegar, by adding to them yeast, or 
any other ferment, and exposing them in vessels to which the air 
has access, in a temperature between seventy-five and ninety de- 
grees. 

Distilled vinegar is sometimes employed as a cooling medicine 
in fevers, being added to any common diluting drink. When taken 
into the stomach it is cooling, promotes a gentle breathing perspira- 
tion, and the discharge of the urine. It allays thirst and diminishes 
excessive heat. In inflammatory fevers, it may be used to acidulate 
barley-water, or any other ordinary beverage of the patient. It is 
also an efficacious remedy for the scurvy, and one of the best means 
of counteracting the fatal effects of overdoses of opium, hemlock, and 
other narcotic poisons. For this last purpose, it should be admin- 
istered in doses of a tablespoonful, frequently repeated, after the 
stomach has been freely emptied by a proper emetic. 

Diluted with water, and applied externally as a lotion, it is 
sometimes of much service in burns, bruises, sprains, and chronic 
inflammation of the eye, and for clearing the eye of small particles 
of lime, when they adhere to any part of the ball, or the lids. Its 
odor is grateful when it is sprinkled on the floor of the chamber of 
the sick in malignant fevers, though it has little efficacy as a fumi- 
gation. 



29 



OTHER CURATIVE AGENCIES. 



ELECTKICITY. 

(Greek, electron, amber.) So called because, by rubbing this sub- 
stance, the existence was first discovered of that subtle fluid which 
appears to be diffused throughout all nature, either in a latent or 
active state, according to circumstances ; we have here only to speak 
of it as an agent in the treatment of disease, in which of late years 
electric, galvanic, or magnetic action has been much employed. 

The effect produced upon the system by electricity is that of a 
nervous excitant and stimulant ; it promotes a freer circulation of 
the fluids, particularly of the blood, increases animal heat, and all 
the secretions and excretions of the body. It has been found chiefly 
useful in deafness, paralysis, head and tooth ache, indeed all neural- 
gic pains ; to parts affected with cramp, gout, and rheumatism, it 
has often been applied with success, and also to foul and indolent 
ulcers. In asphyxia from drowning it should always be employed, 
if the means to obtain the necessary apparatus can be had, although 
only as an adjunct to other efforts. Electricity should not be ap- 
plied when there is active inflammatory disease ; nor when there is 
a high degree of excitement in the organs of sense, and in those of 
voluntary motion, nor when there are great relaxation and debility in 
those organs ; nor when there is any prevailing local irritation, such 
as inflammatory tumors, skin eruptions, etc. The electric stimulus 
in such cases is likely to produce congestion, or a local accumulation 
of humors; the shocks given may be continuous, or a succession 
of smaller shocks, but they should always be regulated by the 
strength of the patient, and never be very violent, or they may 
cause serious mischief. An electric shock can be as well adminis- 



GALVANISM. 441 

tered to twenty persons as one; they have only to join hands with 
him in contact with the conductor, and the fluid will pass through 
them all. 

GALVANISM. 

A form of electricity, so named from its discoverer, Galvani ; it 
is usually elicited by the mutual action of various metals and chem- 
ical agents upon each other, copper and zinc and sulphuric acid 
being those most commonly employed. It is sometimes called Vbl- 
taism, on account of the additional discoveries made by Volta, and 
sometimes Animal Magnetism, from its effects on the muscles of 
animals newly killed. The most simple galvanic battery that can 
be used is a set of tumblers, any even number will do, according to 
the strength required ; about half fill them with water slightly acid- 
ulated with sulphuric or nitric acid, and place them close together 
in a row; put into- the tumbler at one end a broadish strip of zinc, 
and into that at the other a similar strip of copper, and in each of 
the intermediate ones a strip of both metals with their flat sides to- 
gether. Connect the whole by means of a bent wire passing along 
the top ; through this the galvanic current will pass, and also 
through the body of any person who places one hand on the outer 
zinc and the other on the outer copper strip, these being the positive 
and negative poles of the battery. 

The Galvanic Pile may be made in this way : Take twenty or 
thirty pieces of zinc, each as large as a penny, as many pieces of 
copper of the same size, and as many of cloth or paper, which last 
are to be dipped in a solution of salt and water ; then build the pile 
by placing the pieces in this order — zinc, paper, copper ; let it stand 
on a piece of board, and be kept in its position by rods of glass or 
varnished wood. Then, if the hands are wet, and one placed at the 
bottom of the pile, and the other at the top, a slight shock will be 
felt ; and this will be the case every time one hand is withdrawn 
from the pile, or placed on it — thus breaking or establishing the 
electric current passing through the system. 

The Galvanic Trough, a very powerful apparatus, is composed 
of zinc and copper plates placed in pairs, so that the zinc is always 
presented toward one end, and the copper toward the other. 
When the trough is nearly filled with water impregnated with ni- 
tric or muriatic acid, and the points' of the wires which connect the 
two end plates are brought together, the action is very powerful — 
sufficiently so, when the plates are large and numerous, to decom- 
pose water, fuse metal, and work other chemical changes which can 
only be effected by intense heat. 



442 OTHER CURATIVE AGENCIES. 

Galvanic action is now applied to a great variety of useful pur- 
poses connected with art and science ; it differs from that of elec- 
tricity, as formerly applied, in being continuous, the fluid being 
renewed as fast^as it is used; and therefore it never exhausts itself 
while the materials remain which produce it. The patient to whom 
it is applied is only sensible of its application at the commencement 
and finish thereof, and not then unless the current is very strong. 

Medical Galvanism has of late come much into use ; the the- 
ory of its application is, that there are some diseases in which the 
existing electricity in the body should be increased, to bring about 
a cure ; and, on the other hand, others which require it to be de- 
creased. It is, therefore, requisite for the medical galvanist to as- 
certain, by the nature of his patient's complaint, whether the elec- 
tric fluid already circulating in the nerves is too plentiful or insuffi- 
cient ; if the former, he must decrease it ; but, if the latter, increase 
it. ISTow, to increase the electric fluid in the system, we must apply 
the positive pole, or electrode, as it is sometimes called, to the 
hands, feet, or part affected, and the negative to the spine, or back 
of the neck. To decrease it, we must reverse this arrangement, and 
place the positive pole on the back, and the negative on the hands, 
feet, or part affected. We now give a list of those diseases requir- 
ing to be increased, and those for decrease of electricity : 



Increase. 
Amenorrhea. 
Asphyxia. 
Deafness. 
General Debility. 
Hysteria. 
Indigestion. 
Paralysis. 



Decrease. 
Cramp. 
Epilepsy. 
Headache. 
Neuralgia. . 

Profuse and Painful Menstrua- 
tion. 
Rheumatism. 
Tic Douloureux." 



The principal effect of Electro-galvanism, as it is sometimes 
termed, appears to be that of a powerful stimulant to the nervous 
and muscular systems ; but, besides this action, it appears to have 
the power of allaying pain and irritability in the part to which it is 
applied; the reason of this is by no means apparent, and the use of 
the agent must therefore, for the present, be to a certain extent 
empirical. 

MAGNETISM 

Is that peculiar property of certain bodies, particularly iron and 
some of its compounds, by virtue of which they naturally attract or 



MAGNETISM. 443 

repel one another according to determinate laws. This property 
was first observed in the native magnet, or loadstone, as above 
described. 

In considering the nature of this property, we must divide the 
subject into two branches : 1. Electro-magnetism, which compre- 
hends the phenomena resulting from the connection between elec- 
tricity and magnetism ; 2. Animal magnetism, which, on account 
of its real or supposed efficacy in the cure 01 diseases, is that branch 
of the subject with which we have here to do. 

Anton Mesmer, a native of Mersburg, in Suabia, who studied at 
Vienna, and took his degree of doctor of medicine in the univer- 
sity of that city in 1776, was the discoverer of the supposed influ- 
ence of magnetism in human diseases, and the name Mesmerism was 
applied to the theory which he propounded. Notwithstanding the 
extraordinary effects undoubtedly produced by this mysterious 
agent, animal magnetism has never taken very deep root in the 
public faith. At present we hear very little about it, although a few 
years ago it had its advocates and demonstrators everywhere. 
Scientific men generally, who have pursued those branches of study 
which would best enable them to understand the subject, believe 
that its influence is attributable to the effect of an excited imagina- 
tion upon the nervous system of the patient ; the uncertainty of its 
operation favors this impression, and renders it next to useless as a 
remedial agent. There are no known laws by which it can be regu- 
lated ; no principle by which to guide its application. With some 
persons — very many — it is altogether ineffective ; with others, it 
produces effects most strange and incomprehensible. That, by 
means of a few passes of the hands in certain directions over the 
face, a patient should be sent into a deep sleep, which goes the 
length of insensibility to pain — should be rendered generally or lo- 
cally cataleptic, or be thrown into a state of somnambulism, with 
its accompanying conversational power — should be entirely, as it 
were, under the will of the operator, who has the power of remov- 
ing the influence, and restoring the patient to feeling and conscious- 
ness — -all this is so wonderful, and altogether out of the range of 
ordinary phenomena, that we scarcely wonder that, by some, it 
should be attributed to superhuman agency ; the more especially 
when we step forward into the deeper mysteries of Clairvoyance, 
with its pretended insight into things past, present, and future ; its 
intuitive knowledge of all hidden secrets; its ability to read a 
closed book, as well as an open one, and to understand the thoughts 
of the heart before they are expressed. All this, we are told, the 
clairvoyant is able to do, and yet we find that he cannot answer 



444 OTHER CURATIVE AGENCIES. 

some simple question propounded to him while in this peculiar Mes- 
meric state. 

As a remedial agent, then, we cannot count on Mesmerism ; it 
may be of service in some neuralgic cases, those in which, every 
remedy having failed, it may be desirable to give the patient an- 
other chance — a kind of peg to hang a hope on. 

Among the theories which have been propounded to account for 
the effects produced by Mesmerism, two only merit notice. The 
first is that of Mesmer and his immediate followers, who attributed 
the phenomenon to the action of a subtile fluid in the bodies of ani- 
mals, which enables them to exercise an influence on each other at a 
distance, just as a magnet affects iron; hence the name animal mag- 
netism. This hypothesis, of a nervous fluid, susceptible of being 
influenced, and producing an influence more or less modified, was 
adopted by most writers on Mesmerism, until Mr. Braid, by a se- 
ries of experiments, convinced himself and others that the Mes- 
meric state may be produced without any influence from a second 
person, but by simply directing the attention, by means of the eye- 
sight, to some particular object, and keeping it there for a time. 
The state of trance, as it were, so produced, Mr. Braid called hyp- 
notism, and he accounts for the phenomenon by supposing that 
" there is a derangement of the cerebro-spinal centres, and of the 
circulating respiratory and muscular systems, induced by a fixed 
state ; absolute repose of body, fixed attention, and suppressed res- 
piration, concomitant with that fixity of attention." He further 
adds that he believes that in all cases " the whole depended on the 
physical condition of the patient, arising from the causes referred 
to, and not at all on the volition or passes of the operator throwing 
out a magnetic fluid, or exciting into activity some mystical univer- 
sal fluid, or medium." These are the two theories by which the phe- 
nomenon has been accounted for : neither of them is quite satisfac- 
tory. In simple electricity we have known laws to guide us ; electro- 
magnetism and galvanism we can pretty well understand, although 
with respect to the exact nature of these there is yet much to be 
learned ; but here we have only the glimmering light of hypothesis, 
like a will-o'-the-wisp, before us. Before animal magnetism can 
take its place as a true science, we must ascertain its nature, define 
its powers, and be able to calculate, with some degree of certainty, 
not only how it will act in certain cases, but why it does so act ; 
until we can do this we cannot safely employ it in the treatment of 
diseases. 



BATHING. 445 



BATHING. 



By bathing, we understand the whole or partial immersion of 
the body in any medium other than atmospheric air ; it may be 
milk or oil, or medicated vapor, salt or fresh water, hot, tepid, or 
cold, as maybe required; and we commonly understand water to be 
meant when no other medium is expressed. As regards the mode 
of application, it may be total immersion of the body by plunging 
or dipping, by shower, vapor, cold affusion, douche, sponge, or wet 
sheet. 

The object of bathing, besides its great main object, bodily com- 
fort and cleanliness, is to act upon the system through the skin, 
whose nervous irritability, sympathetic power, and extreme vascu- 
larity, and important functions as an excreting organ, admirably 
adapt it for absorbing and conveying through the whole system 
whatever may be brought into contact with it. 

Bathing, as a means of promoting health and comfort, has in all 
ages been valued and practised in warm, and especially Eastern 
climes, as a source of voluptuous enjoyment, to a pernicious extent, 
on account of the enervating influence of the hot bath universally 
employed. In temperate climates cold bathing is more practised 
by those in health, and its effect is altogether beneficial, when due 
moderation is observed, and proper times and seasons. The tem- 
perature of the cold bath may range from 40° or 50° up to 80° or 85° 
Fahr. ; its effect upon the system varies in accordance therewith, as 
well as with the nervous energy of the bather, with the length of 
time he is subjected to its influence, and with the muscular action 
he exerts during that time. As a rule, ten or twelve minutes is as 
long as a person should remain in the water at one time, and but 
one bath should be taken during the day. The best part of the day 
is the morning, before breakfast, especially for a strong, vigorous 
swimmer ; but one of weak and nervous temperament will do best 
to go in about noontide ; with such a bather a change of the hour 
will make all the difference between agreement and disagreement. 
If he comes out of the water with fingers and lips blue and counte- 
nance pale, and, instead of the pleasant glow which ought to follow 
a bath, feels cold, languid, and drowsy, and if a change of the hour 
does not mitigate or alter these symptoms of depression, he must 
give up the cold, and resort to the tepid bath, until the vigor of his 
constitution is in some degree restored. It is always dangerous to 
bathe after a full meal, or when exhausted by great bodily or men- 
tal exertion, and especially so when heated by running or other ex- 
ercise ; on the other hand, it is not well to immerse the body when 



4:4:6 OTHER CURATIVE AGENCIES. 

it is in a chilled state, in this case reaction is doubtful, and the con* 
sequences may be bad. Even in cold climates, a plunge into icy- 
water may be taken with safety by those in full health and vigor ; 
it will not have so depressing an effect upon the system as remain- 
ing long in a bath of a higher temperature, especially if friction 
with some coarse material be used directly after — this should al- 
ways be done after a cold bath. 

Sea-water is undoubtedly better for the bather than fresh, it ex- 
erts a more tonic influence, and its temperature is always more 
agreeable. The proper bathing season in this country is from the 
beginning of June to the end of September ; the temperature of the 
water then ranges from 55° to 70°. Fahr. When it is colder than 
this, should bathing' be ordered for medicinal or other purposes, re- 
sort should be had to 

The Tepid Bath, which should be of a temperature varying from 
85° to 94°, about 88° or 90° being the most convenient and agreeable 
standard. This relaxes and purifies the skin, and promotes insensi- 
ble perspiration, and is most generally applicable for purposes of 
cleanliness and comfort ; it is very soothing and salutary in irri- 
table states of the system, when the skin is dry or chafed, after a 
journey, or any other fatiguing exercises; but, like the cold bath, it 
should not be taken with a full stomach. As a remedial agent, it is 
good in ardent fever, where the temperature is a little above that of 
health ; in diseases of the skin it often produces a salutary reaction ; 
it is useful in chronic rheumatism, and gout, during the attack ; also 
in headaches, colds, and inflammation about the head and throat. It 
has also been employed with good effect in. obstructions of females. 

The Warm or Hot Bath is understood to range from 93° to 
100° Fahr., the standard temperature being about 96°. It ought to 
be employed as a remedial agent only, being too enervating for 
other purposes ; to promote reaction in various stages of coma or 
collapse ; to allay fever, whether spasmodic or inflammatory, soothe 
convulsive action, or to cause fainting when it is desirable to relax 
the tension of muscles and sinews for the reduction of dislocations, 
opening of constricted passages, or other purposes. The hot bath 
has a peculiar tendency to allay local or general irritation, and pro- 
duce sleep ; in complaints of the kidneys and loins, and in puffy 
swellings of the legs, it may be resorted to wfth advantage ; it is 
applicable to weak and irritable constitutions which could not sup- 
port the shock of cold immersions. 

The Shower-Bath is a modern invention ; its construction is 
very simple — a reservoir at the top, perforated with small holes, 
with a plate of metal beneath, which can be withdrawn by means 



BATHING. 44.7 

of a cord by the person inside, on whom the fluid falls through the 
perforations like a gentle shower. This receptacle is supported by 
three or four slight pillars or stems, which form the framework of 
the bath, and a support for the drapery falling down and enclosing 
all like the covering of a tent ; within this, on a seat, with his feet 
in a pan or tub that receives the descending fluid, sits the patient. 

This is a valuable agent in the treatment of various affections, 
and is available for many cases to which the general cold baths 
would not be applied. Its especial advantages are, first, that the 
contact of the water, instead of being sudden and momentary, may 
be gradual and prolonged at pleasure ; second, the first shock of the 
water, falls, as it always should do, on the head and breast, without 
exposing those parts to the danger and inconvenience of contact 
with hard substances, to which they are liable if the bather plunges 
so as to immerse them first. 

The Vapor and Sot-Air Baths are useful for a variety of pur- 
poses ; in paroxysms of gout, acute and chronic rheumatism, various 
skin-diseases, ulcers, lumbago, and sciatica, they are applied with 
advantage ; they are great promoters of perspiration, and have a 
tendency to relax the system. They have been recommended for 
the cure of chilblains, cramps, leprosy, yaws, female obstructions, 
dropsy. The forms of application are various ; a very simple one, 
as good as any, may be extemporized thus : Place on a fire, near 
which the patient can sit or lie, a small kettle of water, with a piece 
of metal tubing attached to the spout, the other end being conveyed 
beneath the blanket, or oil-cloth, in which the patient is enveloped; 
through this, when the water boils, the steam will pass and spread 
itself under the coverlet. Another method is to place a vessel of 
boiling water beneath the coverings of the patient, and keep up the 
supply of steam by putting into it hot stones, or pieces of metal. 
Those who can afford the expense, may obtain more complex and 
perfect apparatus of various kinds of the manufacturers. 

Medicated Baths are those in which the water is impregnated 
with certain mineral, vegetable, and sometimes animal substances. 
Thus we have sulphur, chlorine, and iron baths, aromatic, and milk 
baths, which, if properly prepared and applied, may be productive 
of very beneficial effects. 

The Aromatic Vapor Bath is prepared by passing the vapor of 
boiling water through aromatic plants, from which the active prin- 
ciples are thus carried off. 

A good Alkaline Bath may be prepared thus : Subcarbonate 
of potash eight ounces ; hot water about twenty gallons ; employed 
as a revulsent in chilblains and sanguineous congestions. 



448 OTHER CURATIVE AGENCIES. 

For a Sinapized Foot-bath, add four ounces of flour of mustard 
to the above quantity of water, to determine the blood to the ex- 
tremities, and thus relieve the head. This should not be used too 
hot. 

The Mercurial Bath, employed in venereal affections, is formed 
of bichloride of mercury, from two drachms to an ounce to a gallon 
of water. 

The Sand Bath, or Manuluvium, is prepared with mustard or 
carbonate of soda ; sometimes, with hydrochloric acid. It is used 
in cases where there is a strong determination of blood to the chest, 
and mostly in French practice. 

The Antimonial Bath is composed of tartrate of potash and an- 
timony, of each from four to eight drachms and twenty gallons of 
water. 

The Aromatic Liquid Bath is made by boiling a quantity of 
aromatic herbs, such as lavender, mint, pennyroyal, rosemary, in a 
quantity of water, and then adding the decoction to the water in 
which it is proposed to bathe. 

The Astringent Bath is about half a pound of alum to twenty 
gallons of water. 

The Bran Bath, good as an emollient in severe colds, may be 
made by pouring boiling water upon four pounds of bran, making 
up the quantity to twenty gallons ; if for the feet, for which it is an 
excellent application, of course much less will do. The tempera- 
ture should be about 90°. 

The Hemlock Bath, useful in some skin-diseases, is made thus : 
two ounces of dried hemlock ; boiling water, a gallon ; let it stand 
for several hours, then strain, and bathe the part affected at a tem- 
perature of 90°. 

The Nitro-Muriatic Bath, useful in liver complaints, and where 
there are gall-stones, is one pound of nitric acid and one pound and 
a half of hydrochloric acid, to forty gallons of water ; immerse the 
patient for a quarter of an hour once a day ; this may be continued 
for a fortnight or 'three weeks. 

The Sulphuretted Bath, useful in cases of itch and other skin- dis- 
eases, is made by dissolving four ounces of sulphuret of potash in a 
pint of water, and adding this solution to the requisite quantity for 
immersing the whole person. 

Where sea-water cannot be obtained, a composition for the Sea- 
water Bath may be made as follows : For each gallon of water 
add common salt three ounces and a half; sulphate of soda, com- 
monly called Glauber' s-salt, one ounce and a half ; chloride of calci- 
um, half an ounce ; chloride of magnesia, one and a half ounce. 



FRICTION. 449 

In bathing children, it should he borne in mind that the power 
of producing heat in warm-blooded animals is at its minimum at 
birth, and increases successively to adult age ; hence, the water that 
feels but cool to the nurse's hand may be absolutely cold to an in- 
fant. Some persons are fond of what they call hardening their 
children, by plunging them into cold water in the winter ; but this 
is a pernicious practice, and often produces disease. 

That which is commonly called cold affusion, viz., the pouring 
of a stream of water on the head, when it is desirable to make a 
sudden and powerful impression upon the system, is resorted to in 
cases of poisoning by opium, and other narcotics, as well as by 
prussic acid, or the torpor arising from inhalation of the fumes of 
charcoal, and in hysteric epilepsy, lockjaw, etc. ; also in inflamma- 
tory affections of the brain it is applied with benefit, even to chil- 
dren. The water should be poured on the head held sideways over 
a tub or pan, from a height of several feet ; if the patient is in bed, 
the head can be projected from the side of it ; a large sponge, filled 
with water, and squeezed from some height on the head, will be suf- 
ficient for children ; from one to two minutes should be the period 
of the application. 

The Wet-sheet JBath is formed by enveloping the patient in a sheet 
which has been dipped in cold or tepid water, and then wrung out ; 
over this covering blankets are heaped, and a copious perspiration 
is the result. This, as well as the douche, enters largely into the 
treatment of patients at hydropathic establishments. 



FRICTION. 

As a substitute for exercise, friction may be strongly recommend- 
ed ; it should be applied often and vigorously. Not only does it 
stimulate the parts brought immediately under its influence, and 
cause a healthful glow of the skin, but it calls into action the various 
sets of muscles, and so is in itself a kind of exercise for the whole sys- 
tem ; hence it is better for the bather — who should always have 
friction applied — to rub himself, and not be rubbed, especially in 
cold or temperate climates. 

The value of friction, in a case of asphyxia, or suspended anima- 
tion, from drowning, etc., is so well known that we need scarcely 
insist on it here ; in all cases where there is coldness of the extremi- 
ties from congestion, or impeded circulation, it should be applied 
with promptitude and vigor. Wonders are performed by this simple 
agent alone ; but, for all that, we do not pin our faith to, nor believe 
altogether in, " the movement-cure." Good to a certain extent it 



450 OTHER CURATIVE AGENCIES. 

undoubtedly is, but, like all other remedial agencies, it should be 
used with discretion ; those who claim for it a universal efficacy 
do but injure its real utility. 



FUMIGATION. 

This is a mode of diffusing vapors over a limited space, for the 
purpose of destroying or hiding disagreeable and unwholesome 
smells ; or of applying them to a diseased part, such as the inside 
of the throat, which it would be difficult to reach in any other way. 
The most useful and important kind of fumigation consists in the 
employment of such gases or vapors, which do not merely cover un- 
healthy odors, by exciting others more powerful, but which actually 
destroy them, and by their chemical action prevent the decomposi- 
tion of animal and vegetable substances ; these we term disinfect- 
ants, and chlorine gas is, perhaps, the most efficacious that can be 
used. It may be produced .thus : take powdered oxide of manganese 
and common salt, of each one ounce, mix with about two teaspoon- 
fuls of water, put it into a shallow earthen vessel, and add about 
sixty drops of oil of vitriol ; place the vessel in the apartment to be 
fumigated. The acid may be repeated three times before the man- 
ganese and salt lose their power of evolving chlorine. Chloride of 
lime, of soda, and of zinc, are also good disinfectants, and are much 
used in hospital wards, sick-rooms, water-closets, etc. The first of 
these is the cheapest and the most attainable ; it may be used in solu- 
tion, one part of the salt, which is commonly called " bleaching 
powder," being dissolved in one hundred parts of water ; it may be 
sprinkled about the place, or poured into shallow vessels ; its action 
will be quickened by the addition of a little vinegar, or muriatic 
acid largely diluted. The vapor of burning sulphur, of vinegar, 
and aromatic substances, such as cascarilla, has long been em- 
ployed to hide unpleasant effluvia. The following is a good prepa- 
ration for this purpose: take of bisulphide and nitrate of potash 
equal quantities, peroxide of manganese sufficient to blacken the mix- 
ture ; rub them together in a mortar ; heat a shovel or brick red- 
hot, and scatter some of the powder on it ; then burn a small piece 
of paper which has been dipped into a solution of nitrate of potash 
two parts, sugar one part, and water six parts, and afterward dried. 
The two vapors will combine, and diffuse a most agreeable odor. 

"With regard to the application of the vapor or fumes of metallic 
or other preparations to the throat, or other parts, we can only say 
here that the mode of doing this is, to throw the ingredients upon hot 
iron in a closed chamber, connected with which is a spout like that 



BLEEDING. 451 

of a coffee-pot, through which the vapor is conducted to the point 
of application. 

BLEEDING. 

Bleeding from the arm is the most common mode of depletion 
practised ; the veins there are generally so prominent and accessi- 
ble, that the veriest tyro in surgery can usually manage to open 
them, and abstract the desired quantity of blood, although, from 
his ignorance of the anatomy of the part, he may chance to wound 
a nerve or an artery, and so do serious mischief. Three veins 
pass up the inner part of the forearm, the middle one, when it 
has nearly reached the bend, dividing into two branches. It is 
near this point of division of the median vein into median ba- 
silic and median cephalic, that, on account of its greater promi- 
nence, the lancet is frequently inserted; but it should be borne 
in mind that directly below the upper portion of this lies the bra- 
chial artery ; and that the internal and external cutaneous nerves 
send their minute branches close up on either side, those of the 
former passing before the median basilic, and those of the latter be- 
hind the median cephalic vein. These considerations should induce 
great caution, as an aneurism might result from puncturing the 
artery ; and neuralgia, from a similar accident to either of the nerves. 
It is the safest plan, if the vein is at all prominent, to open the 
median vein before it divides, or the main channel of the ulnar ; 
but, in either case, the method of procedure would be this : Pass 
a broad piece of tape twice round the arm, about three inches above 
the elbow, pull it moderately tight, and tie in a bow on the outside. 
There should have been previously got ready a small piece of lint, 
moistened, and folded up into several thicknesses ; a porringer or 
basin, to catch the blood ; a broom-handle or other stout stick, for 
the patient to grasp ; a wet sponge, and a piece of broad tape, about 
a yard and a half long ; also a lancet, which should be perfectly clean 
and sharp. With the left hand grasp the patient's arm, and 
straighten it out, to make the veins as tense and prominent as pos- 
sible ; then, pressing the thumb of this hand upon the vein at a short 
distance below the spot where the opening is to be made, and hold- 
ing the lancet between the finger and thumb of the other hand, and 
steadying the hand by means of the three disengaged fingers, press 
the instrument into the vein, and give a slight cut upward in with- 
drawing it, so as to make an opening sufficiently large for the blood 
to flow out in a thin stream, which, if the operation is properly per- 
formed, it will do steadily, as soon as the pressure of the thumb 
upon the vein is withdrawn, and perhaps before. From twelve to 



4:52 OTHER CURATIVE AGENCIES. 

sixteen ounces is the quantity of blood usually abstracted ; it should 
be ascertained beforehand how much the basin or porringer will hold. 
When it is sufficiently full, again pressing the thumb on the vein just 
below the opening, loosen the bandage above the elbow, sponge off 
any blood there may be about the cut, bring the edges together, 
and place over it the folded piece of lint previously prepared, press 
the thumb upon that, and then proceed to bandage thus : lay the 
tape obliquely across the wound, pass it round the arm above the 
elbow, and bring it back again over the same spot ; then let it go 
round the arm below the elbow, and, returning, let the two ends be 
tied in a secure bow, in the bend of the arm, with the free move- 
ment of which the bandage should not be tight enough to interfere, 
although it must be sufficiently so to retain its position. This mode 
of bandaging is called the figure of eight, from its resemblance to that 
figure. A skilful operator will make a sufficiently large and clean 
opening for his purpose, yet not always will the blood flow freely ; 
should it not, direct the patient to take hold of the stick before men- 
tioned, and, by alternately tightening and loosening his grasp, he will 
give an impetus to the flow of blood, and so facilitate the completion 
of the operation, which is more effective if performed quickly. The 
bandaging can be performed more readily if the patient's arm is 
kept partly extended, resting upon the bleeding-stick. When the 
bandage is properly tied, the arm can return to its natural position, 
and in about twenty-four hours may be relieved of all pressure ; un- 
til the expiration of this period it should be kept quiet, but should 
any extra exertion cause the slipping of the bandage, and the blood 
burst forth afresh, it may be easily stopped by pressure, applied 
as above directed. During the flowing of the blood, both the coun- 
tenance and the pulse of the patient should be carefully watched ; 
and, should the former become pallid, and the latter diminish in 
force and frequency, it will be necessary to complete the operation. 
If faintness is complained of, this must be done at once, and a re- 
cumbent position should be assumed. 

The accidents likely to result from bleeding are : 

1. The formation of a small tumor round the orifice, occasioned 
by the blood insinuating itself into the cellular tissue while it is 
flowing out of the vessel ; it forms very rapidly, and sometimes im- 
pedes the abstraction of the blood ; a change in the posture of the 
arm will frequently prevent its enlargement, and a removal of the 
bandage will generally do so. Should a sufficient quantity of blood 
not have been taken, another vein in the same or the opposite arm 
may be opened. 

2. Inflammation of the integuments and suppuration of the eel- 



BLEEDING. 453 

hilar tissue in which the vein lies. This is sometimes caused by a 
bad lancet, which does not make a clean cut, but rather lacerates ; 
and it will be especially likely to ensue if there be great irritability 
of constitution. Unsteadiness of the arm during the operation, or 
want of care in bringing the edges of the wound properly together, 
will also tend to produce this. 

Treatment. — Keep the arm at rest in a sling, apply sugar-of- 
lead lotion, give mild saline aperients, and, if suppuration ensues, 
poultice with bread and water. 

3. Inflammation of the absorbents, often occasioned by motion 
of the arm soon after bleeding ; indicated by swellings over the 
course of the larger vessels, with pains shooting from the point of 
venesection up and down the arm. There is much inflammation at 
the opening of the vein, and finally suppuration. 

Treatment. — Same as above, with the free application of the 
lancet to the wound, should it assume the character of an abscess. 

4. Inflammation of the vein. This is likely to arise when the 
edges of the wound made by the lancet do not readily unite ; it 
may vary greatly in degree, extent, and progress, and the treat- 
ment, although in the main similar to that above recommended, 
will accord with the peculiar circumstances of the case. Care 
should be taken to prevent the inflammation from extending along 
the membranous lines of the vessel to the heart, by placing a com- 
press over the vein a little above the puncture. 

5. Inflammation of the fascia of the forearm, a consequence of 
an inflamed state of the vein where punctured ; the whole arm be- 
comes stiff and painful, the joints cannot be moved, nor the fingers 
extended, without much suffering ; the enlargements are sometimes 
affected with a kind of erysipelas ; there are swelling of the arm 
and a considerable degree of fever in the system. In about a 
week, a superficial formation of matter takes place, for which a way 
of escape should be made ; it will probably form again, and require 
a second, and perhaps a third, opening, but eventually is quite got 
rid of, and the patient gradually recovers the use of his arm. The 
treatment the same as usual in inflammatory diseases ; in the latter 
stages, friction for the fingers, elbow-joint, and fore-arm, with cam- 
phorated mercurial liniment ; and, if necessary, extension by means 
of a splint. 

6. Wounded nerves. This is known by a sensation of acute 
pain in the parts which the particular nerve supplies, such as is felt 
in tic douloureux, and other neuralgic complaints ; in some instances 
violent convulsions have ensued, and other symptoms attributable 
to nervous irritation. If anodynes do not succeed in allaying this, 



454 OTHER CURATIVE AGENCIES. 

a complete severance of the injured nerve is recommended ; and this, 
of course, only a surgeon would attempt. 



CUPPING. 

The abstraction of blood by means of the cupping-glass, in which 
a partial vacuum has been produced by the application of heat 
within, causing the air to expand ; this, as it cools, condenses again, 
and so draws up the skin of the part to which the glass is applied, 
and causes the blood to flow through the openings made by the 
concealed lancets of the instrument called a scarificator, which 
is a metal case containing several lancets (ten or twelve is the 
general number) of semicircular form, which, when set, on the pressure 
of a spring revolve rapidly on an axis, and, protruding through slits 
in the bottom of the case, make so many clean cuts, with very little 
pain to the person operated on ; the depth of these cuts can be regu- 
lated by a screw, according as the judgment of the operator directs ; 
the setting of the instrument is effected by means of a trigger. 
Cupping, although it requires a quick and practised hand to do it 
expertly, and with perfect success, is frequently performed as a 
purely domestic operation, nor can there be any objection to this, 
provided the desirability of extracting blood from any particular 
part of the frame is first clearly ascertained. The mode of operation 
is this : Let the part to be operated upon, most frequently the neck, 
the back, or the loins, be bared, and the patient placed in a con- 
venient position — one which can be maintained for a considerable 
space of time. First, apply to the part a sponge, or a flannel dipped 
in hot water, to excite a quicker circulation ; then, take a cupping- 
glass — one of several previously placed at hand — into which has been 
put a small piece of paper saturated with spirits of wine ; place one 
edge of the glass on the skin of the patient ; ignite the spirit by the 
introduction of a match or screw of paper, and immediately press 
the glass closely down ; it will adhere by the power of suction until 
the air is admitted by the insertion of a finger-nail beneath the edge. 
Fix two or three glasses in this way ; then remove them ; and, to 
the centre of each swelling of the skin which they raise, apply the 
scarificator, pressing it closely down each time, and causing the 
lancets to make incisions by the means already described; do this 
rapidly, and again affix the glasses, charged with spirit. If this is 
properly done, the blood will flow rapidly into them ; and when half- 
filled, or more, they should be removed, the cuts sponged with warm 
water, to clear them from coagulated blood, and fresh glasses applied, 
continuing in this way until the necessary quantity of blood is ab- 



LEECHES. . 455 

stracted ; this may be from six to twelve ounces, according to cir- 
cumstances, but eight or ten ounces is the usual quantity. If the 
blood does not flow freely, or, as is sometimes the case, ceases after 
a short time to flow at all, a removal of the glasses, and warm spong- 
ing, must be tried ; if this is not effectual, cross-cuttings with the 
scarificator should be made, or fresh incisions on a part more favor- 
able for the operation ; this should not be where there is much fat or 
muscle, nor where the surface is very uneven or covered with hairs, 
as in neither case can the glass fix sufficiently close to exclude the air. 
None but a very dexterous cupper should operate on a part where 
the skin is at all thin, as on the temple, where nice judgment and 
delicate manipulation are required. Having taken the requisite quan- 
tity of blood, and removed the glasses, which may be done without 
spilling any of the fluid, if, simultaneously with lifting the upper 
edge of the glass, a sponge or flannel, is passed rapidly over the sur- 
face, so as to sweep the blood into the vessel, cleanse the incisions, 
and then apply over them strips of soap or adhesive plaster ; the 
bleeding ceases immediately, and the cuts generally heal in a few 
days, without pain or annoyance of any kind. 

The process of extracting blood by cupping was practised by the 
ancients, and some barbarous nations still perform it in a very primi- 
tive way. Incisions are made by means of a sharp flint or knife, and 
over these is applied a cow's-horn with the top removed, to the aper- 
ture of which the operator applies his mouth, and literally sucks the 
blood of his patient. The operation as now performed is safer for 
the unqualified practitioner than either leeching or bleeding ; and it 
frequently affords very speedy relief in inflammatory and some other 
diseases. • 

LEECHES. 

Before applying a leech, it is best to let it crawl for a short time 
on a clean dry napkin or towel ; and, if after that there is any diffi- 
culty in getting it to fix, smear the part with a little milk and Sugar 
mixed, and made rather warm. If, in consequence of cold, the 
creature appears sluggish and inactive, put it into water at a tem- 
perature of about seventy degrees, with a couple of table-spoonfuls of 
porter in it. Should it be desirable to detach the leech before it has 
done sucking, do not pull it off forcibly, but sprinkle a few grains 
of salt on its head. The old practice, of putting the creature when 
gorged into a plate of salt, is not a good one ; the better plan is to 
immerse it in a solution, not very strong, of this substance, and, when 
it has thrown up as much blood as it will, to " strip " it thoroughly, 
by holding the tail end firmly between the finger and thumb of the 
30 



156 OTHER CURATIVE AGENCIES. 

left hand, and drawing it steadily between those of the right, nearly 
up to the head. This is a disagreeable process, but it is the most 
effectual for cleansing the animal, so that it may be preserved for 
future use. It should be put into clean fresh water, which, for the 
first three or four days, should be changed twice a day; afterward, 
every four or five days will do. The temperature of the water should 
not be lower than fifty degrees Fahr., and the place in which it is 
kept should be airy, and free from strong odors — the vessel, a wide- 
mouthed jar or bottle, about half-filled, with a little clean sand at 
the bottom ; the top covered with a piece of muslin or gauze. 

Upon an average, leeches are said to take about one drachm of 
blood each, which, with what flows after, may be increased to half 
an ounce ; this may be taken as the basis of calculation required as 
to the quantity to be abstracted. 

It is, however, impossible to regulate the flow very nicely by this 
method of phlebotomy; therefore, in all cases where bleeding or 
cupping can be at all conveniently performed, one or other of these 
means should be resorted to : when leeches are applied, it should be 
over a bone, against which pressure can be made, if necessary, to 
stop the bleeding, and never on a soft part, such as the neck or ab- 
domen, especially with children, who have sometimes died from loss 
of blood, the flow of which it has been found impossible to stop, in 
consequence of there being no basis for the application of pressure. 
The best and simplest way of applying leeches is to confine them to 
the desired spot within an inverted wineglass, through the sides of 
which it can be seen when they have bitten ; a large pill-box, which 
is sometimes used, has not this advantage, and must be frequently 
lifted, by which the animals are disturbed, and bftes sometimes pre- 
vented. Putting them on individually, holding the leech by the 
larger end in a towel or napkin, is a very tedious process, and letting 
them crawl at will over the surface, a very uncertain one, as to the 
exact spot on which they will fasten. If it is to such a part as the 
interior of the mouth from which the blood is to be extracted, a 
leech-glass must be used in this manner : Put the leech, head- 
foremost, into the broader end of the glass ; it will naturally slide 
to the smaller end, which must be applied to the gum or other dis- 
eased spot, so that the creature cannot escape, and if at all inclined 
to bite will soon do so ; the glass must be kept in its position until 
the sucking is over, and the hold of the leech is loosened, when it 
can be removed without any unpleasant contact with the mouth. 
This mode can also be adopted with the vagina, or other part near 
the surface of the body whence it is desirable to abstract blood. 

Leeches are unable to bite where the skin is very hard and 



BLISTERS. 457 

tough, and they will seldom fix where there are any hairs. If the 
surface on which they rest is not smooth and soft, they will often 
drop off before they have sucked their fill, and this is too likely to 
occur if they are suffered to depend from the point of suction. 
When they come off, it is usually desirable to encourage the flow of 
blood, and to this end a hot bread or bran poultice should be 
applied; or, if this is objectionable on account of the moisture, 
several folds of linen made quite hot and placed over the bites will 
do ; this should be replaced with dry folds when they become sat- 
urated with blood. In many cases, however, and especially with 
children, the difficulty is to stop the bleeding before it proves too 
exhausting ; this may sometimes be accomplished by placing a pad 
of lint over the bite, and keeping a firm pressure on it with the 
forefinger for some minutes, that is, supposing there is bone beneath 
to press upon. When the flow seems arrested, it is best not to re- 
move the pad at once, but keep it in its place with strips of adhe- 
sive plaster. If the simple lint does not answer, try a pad soaked 
in a strong solution of alum, and, if this fails, apply a pointed piece 
of lunar caustic to the bite. As a last resource, take a sewing- 
needle, pass it through the wound from side to side, and then twist 
cotton or thread tightly round it in the letter-S form. 

It has sometimes been found needful to apply actual cautery — 
a wire or skewer heated to a white heat. These are desperate ex- 
pedients, but it is better to resort to them than let a child or weak- 
ly person bleed to death. Generally, pressure, firmly and judicious- 
ly applied, will be sufficient. 

It should be borne in mind that leech-bites, after the bleeding 
has apparently stopped, will sometimes burst out afresh ; therefore, 
children who have been leeched and put to bed ought to be careful- 
ly watched. It is best, if possible, to avoid applying leeches to a 
child toward night, on account of this danger. 

In persons predisposed to inflammation, a leech-bite will some- 
times assume an angry, erysipelatous appearance. Perhaps there 
will be considerable swelling and pain, but this is generally subdued 
by the application of Goulard's lotion. 

BLISTERS. 

The chief blistering agent used by medical practitioners is the 
Spanish fly. But the application of any highly-irritating substance 
will produce the same effect. Steam, strong ammonia, mustard, horse- 
radish, croton-oil, tartar-emetic, and many other applications, will ex- 
cite this inflammatory action, and cause the formation of a blister, but 



£58 OTHER CURATIVE AGENCIES. 

scarcely any so speedily and so effectually as the agent first named, 
which is generally applied in the form of a plaster — the emplastrum 
cantharidis, or lyttce, of the pharmacopoeia. There is also an ex- 
tract prepared by evaporating a tincture composed of four parts of 
the flies to one of strong acetic acid and sixteen of rectified spirits ; 
and aceturn lyttce, formed of the above acid and the insects. The 
latter preparation has merely to be applied with a camel-hair brush ; 
it is very speedy in its operation. The old and still generally pur- 
sued method is to spread the blister plaster pretty thickly on leather, 
adhesive plaster, calico, or linen, and place it on the part affect- 
ed, putting a handkerchief round to keep it close to the skin. In 
ten or twelve hours it ought to produce the desired effect ; it may 
then be taken off, the vesicle clipped with a pair of sharp scissors 
to let out the fluid, which should not be suffered to run down the 
body, as it will produce painful excoriations; keep the blister 
dressed with spermaceti or elder-flower ointment, until healed. 
Sometimes a little of the powdered fly is sprinkled over the outside 
of the plaster when spread, and previous to its application, and 
sometimes a few grains of tartar-emetic ; these increase the activity 
of the application, but are apt to produce strangury. 

The best time for the application of a blister is the evening, and, 
as soon as it is on, the patient had better retire to bed, and, if possi- 
ble, get to sleep. If at the end of twelve hours it is found not to 
have risen well, it must remain on longer. With persons far ad- 
vanced in life, or who have a particularly dry skin, or are in a state 
of great nervous depression, sixteen or even twenty hours may be 
required for the full effect of the irritant to be produced. The ac- 
tion may be assisted, and the removal of the plaster facilitated, by 
rubbing the part, previously to application, with olive-oil, or by in- 
terposing a thin piece of muslin between the plaster and the skin ; 
this, of course, refers to the old form of application. For children, 
and those who have tender and delicate skins, the action of a blis- 
ter should be carefully watched, as the effect is often produced in a 
shorter time than is usually required. The plaster should be re- 
moved as soon as it begins to rise, and a warm bread-poultice ap- 
plied ; under its influence the full rising will generally take place. 
When the vesicle is punctured, and the fluid emptied upon a cloth 
placed to catch it, allow the membrane to subside and apply the 
dressing. It is sometimes erroneously imagined that the rising has 
only taken place at one part of the vesicated surface, because a 
bladder only appears there ; but a close examination will show that 
the bladder extends over the whole, but is only obvious at the low- 
er portion, where the fluid has gravitated ; sometimes, instead of one 



ISSUR 459 

large bag, there are several small vesicles — these should all be 
clipped, unless very small. When, instead of watery fluid, the blis- 
ter contains a thick pus, which does not flow out, there should be 
no squeezing to make it do so ; it will gradually ooze out into the 
dressing, which may be ointment spread upon lint, as before men- 
tioned, or cotton wadding, which has been recently employed with 
good results. 

" Flying blisters " are those which are taken off as soon as red- 
ness is produced : weak mustard-poultices will answer this purpose. 
The non-rising of a blister frequently gives much alarm, it being a 
popular impression that the absence of susceptibility of the skin is 
owing to a deficiency of vital power ; but very trivial causes will 
sometimes prevent the expected effect taking place. 

Persons liable to affections of the kidney should never be blistered, 
except with medical sanction. Much harm is often done by resort- 
ing too hastily to this method of obtaining relief in cases of fever 
and acute inflammation ; by the irritation produced, the general 
symptoms are aggravated, without affording the expected amount 
of local relief. It is always best to consult a surgeon before making 
the application. 

By all this it will be seen that blisters are chiefly useful as 
counter-irritants. They are applied over the seat of some active 
disease, as pneumonia, gastritis, hepatitis, phrenitis. They are also 
applied with good effect in spasmodic affections. 



ISSUE. 

An ulcer purposely made, and kept open for the cure or preven- 
tion of disease : this may be termed an artificial sore, from which a 
discharge of matter is kept up for the purpose of producing derivative 
action, and thus affording relief to some part of the system threatened 
or attacked. There are several ways of forming an issue, such as 
applying caustics, or a red-hot iron, to the part ; but the most 
common, and perhaps the best plan for popular use, is that made by 
pinching up a fold of the skin, and making an incision with a lancet, 
or other sharp instrument, sufficiently large for the insertion of two 
or three peas, which are kept in by a strip of adhesive plaster. 
The irritation which they occasion will in a few days produce a dis- 
charge of matter ; the peas should be taken out, and fresh ones in- 
serted every day, while it is desirable to keep the issue open. A 
blister, kept open by repeated renewals of the irritating matter, is 
an issue ; so is an application of ointment of tartarized antimony, or 
any irritant sufficiently strong to produce a running sore. Caustio 



460 OTHER CURATIVE AGENCIES. 

potash, is sometimes used for the purpose, thus : Spread a piece of 
leather with diachylon, cut a hole in the centre as large as the issue 
is desired to be, warm, and stick it on to the seat of the intended 
issue ; then spread the potash over the circular patch of skin left 
unprotected by the leather — it will soon change to a brown color ; 
then apply a linseed-poultice, and renew it night and morning until 
the slough comes out, and leaves a small cavity, into which put two 
or three peas, previously prepared by being soaked in a solution of 
sulphate of copper, in the proportion of about half a drachm to an 
ounce, and dried ; over the peas place a piece of soap-plaster, and 
secure it tightly to the surrounding skin, and also by a bandage ; 
the moisture will cause the peas to swell and press inwardly, and so 
irritate and inflame the wound, causing a formation of matter ; they 
must be renewed daily, as in the cases before mentioned. 

PLASTEKS. 

These are compounds of gummy resins, and other adhesive and 
tenacious substances, used as outward applications. They may be 
either simply adhesive, as the common diachylon, or sticking-plaster, 
or the isinglass or court-plaster ; they may be protective, as the lead- 
plaster ; stimulating, like Burgundy-pitch ; or warm, like cummin- 
plaster, etc. Out of a long list of pharmaceutical preparations of 
this class, we cite the following as the most adapted for domestic 
use: Common adhesive or diachylon, isinglass, and soap plasters, 
are simply protective, as is also the lead-plaster ; belladonna and 
opium, anodyne; cantharides, or lyttse, blistering; cummin, and 
galbanum, warm and stimulant ; mercurial, discutient ; robrans, or 
iron, supporting and strengthening — the latter is commonly used as 
an application to weak or relaxed parts, such as the wrist or ankle, 
after a sprain ; or the back, when the spine wants support ; both 
cummin and galbanum are used for the same purpose, but these are 
too stimulating for many skins, causing unbearable irritation ; 
indeed, with some, even robrans will do this; in such a case the 
lead-plaster had better be applied. The latter is one of the best 
protections for the backs and other parts of those who are obliged to 
lie much in one position. This should be kept in the roll, and spread 
when wanted ; as, if kept spread, it very soon cracks and peels 
off. Most plasters intended for use in this or other temperate cli- 
mates had better be purchased ready for use, as the spreading, which 
is done by machinery, is much more smooth and even than can be 
effected by the hand. Emigrants going to hot countries should take 
plasters in the roll, and spread the mas required, upon any convenient 



POULTICE. 461 

material ; even paper will do, if leather or calico cannot be readily- 
procured ; they should take with them a plaster spatula. 

When wanted for use, thrust the flat end into a fire, and let it 
remain until sufficiently heated to dissolve the plaster without 
causing discoloration; before it is applied to the substance to be 
melted the heated part should be rubbed on a mat, or other rough 
place, to cleanse it ; if much smoke arises on the application of the 
iron to the roll, the former is too hot, and should be dipped into 
water. Let the plaster drop all over the substance on which it is to 
be spread, and then with the spatula blend the little lumps, and rub 
it down until an even surface is obtained; it is best to leave a clear 
margin of about a quarter of an inch all round. It is a popular 
fallacy to suppose that plasters exert any healing influence ; they 
merely protect injured parts from external influences, and, by keep- 
ing the edges of wounds, etc., in close apposition to each other, al- 
low the healing powers of Nature to have fair play. , For wounds, 
cuts, etc., there is no better adhesive application than the common 
diachylon and soap plasters, and one or other of these should al- 
ways be kept in a house. 

To remove plasters in the least painful manner, and without 
danger of injuring the raw parts beneath, it is necessary to damp 
them for some little time with a sponge soaked in warm water, or, if 
it is in the hand or any part that can be so treated, immerse it 
therein for some time ; the plaster will then come off easily, if the 
strips be taken up separately, beginning at the side farthest from 
the seat of injury. 

POULTICE. 

On the utility of poultices in cases where the application of 
warmth and moisture is required we need not here insist, for all 
who have had any thing to do with the treatment of disease are 
fully aware of this. Very often, however, they fail of producing 
the expected good effects because they are not properly prepared 
or applied ; we therefore deem it well to give directions for the 
preparation of those most commonly employed. 

Bread-and- Water Poultice. — Put into a basin a sufficient quan- 
tity of bread-crumbs, and cover with boiling water ; let the mixture 
stand with a plate over to keep in the steam for a minute or two, 
then draw off the water, and turn out the contents of the basin into 
a piece of folded linen, sufficiently large to cover the affected part ; 
to which, having first spread over it a little lard, to prevent its 
sticking when dry, apply the poultice next the skin, keeping it close 
by means of a bandage, or wrapper of some kind. If not required 



4:62 OTHER CURATIVE AGENCIES. 

warm, merely soak sufficient bread in cold water, and apply it, when 
saturated, on a fold of linen, as directed above. 

Linseed-meal Poultice. — Pour some boiling water into a basin, 
and add gradually the meal, stirring with a stick until the mixture 
becomes quite a stiff paste ; then spread it an inch thick on folded 
linen, and apply. 

Mustard-Poultice. — To make this, take as much as may be re- 
quired, in equal proportions, of best flour of mustard and linseed- 
meal, or bread-crumbs ; put them into a basin previously warmed, 
and add gradually as much boiling water as may be necessary ; 
grease, and apply as above directed ; or simply mix the mustard 
with hot water, spread the paste on linen, place over it a piece of 
muslin, and place it next the skin ; if it is desirable to make it more 
stimulating, some scraped horse-radish will have this effect. The 
length of time that a mustard-poultice may remain on must be regu- 
lated in great measure by the feelings of the patient. 

Yeast-Poultice. — Add to half a pound of linseed-meal, in a 
basin, a quarter of a pint each of beer-yeast and water heated, mix 
gradually with spoon or stick : spread on linen, and apply. It 
should be renewed every six or eight hours, as should the linseed- 
meal poultice. 

Charcoal-Poultice. — Add to a common bread-and-water poultice, 
while quite hot, about an equal quantity of linseed-meal and char- 
coal ; mix, spread on linen, and apply. Useful for gangrenous and 
fetid sores. 

Salt -and -Water Poultice. — This is made like one of bread and 
water, by merely dissolving a tablespoonful of common salt in the 
water previous to mixing : this is recommended by Cooper for 
chronic abscesses. . 

Almost any soft substance which will retain heat and moisture 
may be used to form a poultice, which should be perfectly smooth, 
and free from lumps or hardness ; recently a preparation called 
spongia piline has been employed ; this has merely to be soaked in 
a hot liquid, drained out, and laid on with oil-skin, or some other 
waterproof material, over it ; indeed, all poultices should be so cov- 
ered, the heat and moisture being thus retained longer than they 
otherwise can be. 

Arrow-root Poultice. — This is recommended as a soothing appli- 
cation for irritable sores, etc. Hops, chamomiles, scraped carrot and 
turnip, and a variety of other substances, are also used for this pur- 
pose, but it is doubtful whether they possess any advantages over 
those more commonly employed. 

Poulticing of wounds and abscesses is sometimes carried too far. 



BANDAGES. 463 

Up to a certain point it is good ; but when the discharge becomes 
thin and serous, and increases rather than diminishes, and the heal- 
ing process appears to stop, it is time to stay this kind of applica- 
tion, and substitute water-dressing, which often gives a more 
healthy character to the affected part. 



BANDAGES. 

There is not a more important art connected with household 
surgery than that of bandaging. To do it well requires much prac- 
tice and no little judgment ; even hospital dressers are not always 
perfect in this branch of their operations ; and " family doctors " 
not infrequently make a sad bungle of bandaging a leg or an arm. 
On the other hand, we have seen it so deftly performed, that no 
piece of machinery work could excel it ; so smooth and regular, so 
compact and firm, every fold and diagonal turn falling into its ex- 
act place, and maintaining its proper relative position ; each layer 
of even texture fading off, as it were, from its fellow, and in turn 
supporting another, with no undue strain nor pressure or any part : 
the very perfection of close binding. We do not expect many of 
our readers to accomplish this ; but it will be as well for them to 
understand how it is done, that they may, when the emergency 
arises, know how to go about it. First of all, what is a bandage ? 
Something that binds, a fillet, a piece of linen or cloth for binding 
up a wounded limb. The material employed for this purpose is 
usually stout unbleached muslin, from two or three to nine or ten 
inches wide, and from six to twelve yards long ; the former length 
and breadth will do best for the leg. If commenced at the ball of 
the foot, and evenly applied, so that each fold overlaps the other 
about one-third, it will reach to the knee ; the following cut will 
best show the mode of application. The bandage having been first 
tightly rolled up, is taken in the right hand of the operator ; the 
end is passed under the foot, and held there by the left hand until it 
is secured by one turn of the bandage over it ; an upward direction 
is then taken, so that a couple of folds bring the bandage up to the 
front of the leg, over the instep ; the next turn will naturally pass 
above the heel behind ; and then, if proper care be observed, it will 
go on fold above fold, each overlapping the other slightly, all up the 
leg ; the bandage is passed from the right to the left hand each 
time that it goes round the leg, and great care should be taken to 
hold it firmly, and equalize the pressure, as well as to smooth out 
any wrinkles that may occur in the process of binding. A firm and 
even support is thus afforded to the limb, which is not likely to 



464: 



OTHER CURATIVE AGENCIES. 



crease, or get displaced by the motion which may be afterward ne- 
cessary ; it may be made fast above the calf by a couple of pins, or 
a needle and thread. Great care should be taken in this, as in all 




similar operations, to get the bandage rolled up tightly and smooth- 
ly, before commencing — it may thus be grasped in the hand, and 
kept well under the command of the operator, who should on no 
account let go his hold of the bandage, so as to relax the pressure. 

The arm does not require so long or broad a bandage as the 
leg ; about two inches, by three or four yards, being the average 
size : this limb is rather more difficult to manage, half turns being 
necessary to effect a proper envelopment. How this is effected may 
be seen by the following cut ; the bandage is folded back upon it- 
self, so as to take a different direction, and cover the space which 
would be left exposed by the ordinary method of folding ; these 
half turns, unless they are done tightly and evenly, will be very apt 
to slip and derange the whole binding. Some operators avoid half 
turns, by letting the roller take its natural course, and, then coming 




back to cover the exposed parts ; but this method, besides requiring 
a larger bandage, does not effect the required purpose so neatly 
and efficiently. One mode of fastening a bandage is to split it up a 
short distance, so as to leave two ends, which can be passed round 
the limb, and tied. It should always be borne in mind that the 
chief art in applying bandages is to give firm and uniform support, 



BANDAGES. 465 

without undue pressure upon any part ; and, to effect this properly, 
the strain in winding should be upon the whole roll held in the 
hand, and not upon the unrolled portion of it; and this strain 
should not be relaxed during the progress of the operation. 

The next cut represents the mode of applying what is called a 
many-tailed bandage, useful to apply over a wound, or wherever 
it requires frequent changing, or in cases in which it is desirable not 
to exhaust the patient by much movement of the limb. This is a 
strip of calico somewhat longer than the limb to be enveloped ; on 
it are sewn, at right angles, other strips, about one-half longer than 
the circumference of the limb, each overlapping the other about one- 




third of its breadth, so that, when drawn tightly over in regular suc- 
cession, each secures the other; the end of the strip passes under the 
heel, and, coming up on the other side, is made fast to the bandage 
there, and so all is kept firm. 

For keeping poultices on the lower part of the back, or in the 
groin, a cross-bandage is used, the fashion of which is this : make a 
calico band large enough to pass ronnd the loins, and tie a buckle in 
front ; to this is attached another piece, which proceeds from the 
centre of the back to the anus, where it divides into two, which pass 
under the thighs, up on either side, and are fastened to the band in 
front. The bandage used to close a vein after bleeding is com- 
monly called a figure of eight; it is more fully described under 
Bleeding. 

For a sprained ankle, place the end of the bandage upon the in- 
step, then carry it round, and bring it over the same part again, 
and thence round the foot two or three times, finishing off with a 
turn or two round the leg above the ankle. 

For a sprained wrist begin by passing the bandage round the 
hand, across and across, like the figure 8 ; exclude the thumb, and 
finish with a turn or two round the wrist. 

For a cut finger, pass the bandage, a narrow one, round the 
finger several times, winding from the top, and, splitting the end, 
fasten by tying round the thick part above the cut ; or, if it be high 
up, tie round the wrist. 



OTHER CURATIVE AGENCIES. 

The best bandage for the eyes is an old silk handkerchief passed 
over the forehead, and tied at the back of the head. For the head 
itself, it is best to have a cross-bandage, or rather two bandages ; 
one passing across the forehead, and round the back of the head, and 
the other over the top of the head, and below the chin, as in the fol- 




lowing cut. Or, better than this is, perhaps, a large handkerchief 
which will extend all over the forehead and crown, two ends of it 




passing to the back, and, after crossing from thence round the neck, 
then tying the other two beneath the chin. 

For a bandage to support a pad or poultice under the armpit, a 
handkerchief may be used, put on as in the following cut ; or a 
broad piece of calico, arranged in the same way. 

For fracture of the ribs, bandages should be about nine inches 
wide, and drawn round the body very tightly ; in this case, as in 
that of any other fracture or dislocation, only a properly-qualified 
person should attempt their application. 



BANDAGES. 



467 



We have not yet spoken of the T-bandage, which is simply a 
broad band to pass round the body or elsewhere, having attached to 
it one of the same width, or narrower, like the upright part of the 




letter after which it is named ; or, there may be two stems, if they 
can be so called, in which case it is a double T-bandage, as under. 

Starch-bandages are those in which the roller, before it is put on, 
is saturated in a strong solution of starch. Sometimes a covering 
of brown paper is put over this, and another dry bandage is ap- 




plied ; this makes a firm and compact case for the limb : it is useful 
in cases of fracture, especially if the patient has to be removed to a 
distance. Sometimes, when it is not desirable to make the covering 
so thick and durable, the displacement of the bandages is guarded 
against by brushing a weak solution of starch or gum over the folds. 
Bandaging should be performed in nearly all cases from the ex- 
tremities upward, or inward to the heart, except where the injury is 
situated above the seat of vital action. If they give much pain, 
there is reason to suspect inflammatory swelling beneath, and they 
should be loosened, if moistening with cold water does not relieve 
the pain. Flannel for bandages is used where warmth as well as 
support is required. 



THE END. 



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MIND: 

Jl QUARTERLY glJZVTZJW 

OF 

PSYCHOLOGY AND PHILOSOPHY, 

EDITED BY 

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-***- 



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DESCRIPTIVE CATALOGUE 



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Medical Woees, 




D. APPLETON & CO., 



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549 & 551 BROADWAY, NEW YORK, 



1875. 



■■ 



INDEX OF SUBJECTS. 



PAGE 

Anatomy 15 

Anaesthesia 25 

Acne 31 

Body and Mind 17 

Breath, and Diseases which give it a Fetid 
Odor 15 

Cerebral Convolutions 7 

Chemical Examination of the Urine in Dis- 
ease 8 

Chemical Analysis 13 

" Technology 30 

Chemistry of Common Life 16 

Clinical Electro-Therapeutics 10 

" Lectures and Essays 31 

Comparative Anatomy 6 

Club-fool; 24 

Diseases of the Nervous System 11 

" " " Bones 18 

" " Women 25, 26 

" " the Chest 25 

" Children 24, 28 

" " the Kectum 23 

" " the Ovaries 30 

Emergencies 14 

Electricity and Practical Medicine 19 

Foods 24 

Galvano-Therapeutics 22 

Hospitalism 25 

Histology and Histo-Chemistry of Man 8 

Infancy 6 

Insanity in its Eelation to Crime 10 

Materia Medica and Therapeutics 22 

Medical Journal 32 

Mental Physiology 5 



PAGB. 

Midwifery 25, 26; 

Mineral Springs 29> 

Neuralgia 3 

Nervous System 11, 12 

Nursing 22 

Obstetrics 4, 7, 25- 

Orthopedic Surgery 31 

Ovarian Tumors 28 

" Diagnosis and Treatment 30* 

Paralysis from Brain -Disease 81 

Physiology 9, lfr 

Physiology of Common Life 16 

Physiology and Pathology of the Mind IT 

Physiological Effects of Severe Muscular Ex- 
ercise 11 

Pulmonary Consumption 5 

Practical Medicine 20 

Physical Cause of the Death of Christ 25 

Popular Science 32 

Puerperal Diseases 2 

Reports 4 

Recollections of Past Life 14 

" of the Army of the Potomac... 16- 
Responsibility in Mental Diseases 18- 

Sea-Sickness 2 

Surgical Pathology 5- 

" Diseases of the Male Genito-Uri- 

nary Organs 2T 

Surgery 7 

Syphilis 27 

Science 80, 32 

Skin-Diseases 21 

Therapeutics 81 

Uterine Therapeutics 26 

Winter and Spring 4 



CATALOGUE 

OP 



MEDICAL WORKS 



ANSTIE. 

IN CUrctlglcl, and Diseases which resemble it. 

By FRANCIS E. ANSTIE, M. D., F. R. C. P., ' 

Senior Assistant Physician to "Westminster Hospital ; Lecturer on Materia Medica in "Westminster 
Hospital School; and Physician to the Belgrave Hospital for Children; Editor of "The 
Practitioner" (London), etc. 

1 vol., 12mo. Cloth, $2.50. 
u It is a valuable contribution to scientific medicine."— The Lancet {London). 

BARKER 
The Puerperal Diseases, cunicai Lectures 

delivered at Bellevue Hospital. 

By FORDYCE BARKER, M. B., 

Clinical Professor of Midwifery and the Diseases of "Women in the Bellevue Hospital Medica! 
College; Obstetric Physician to Bellevue Hospital; Consulting Physician to the New York 
State Woman's Hospital; Fellow of the New York Academy of Medicine; formerly Presi- 
dent of the Medical Society of the State of New York ; Honorary Fellow of the Obstetrical 
Societies of London and Edinburgh ; Honorary Fellow of the Eoyal Medical Society of 
Athens, Greece, etc., etc., etc. 

Third Edition. 1 vol., 8vo. Cloth. 526 pages. Price, $5.00. 

"For nearly twenty years it has been my duty, as well as my privilege, to give clinical lect- 
ures at Bellevue Hospital, on midwifery, the puerperal and the other diseases of women. This 
volume is made up substantially from phonographic reports of the lectures which I have given 
on the puerperal diseases. Having had rather exceptional opportunities for the study of these 
diseases. I have felt it to be an imperative duty to utilize, so far as lay in my power, the advan- 
tages which I have enjoyed for the promotion of science, and, I hope, for the interests of human- 
ity. In many subjects, such as albuminuria, convulsions, thrombosis, and embolism, septicaemia, 
and pyaemia," the advance of science has been so rapid as to make it necessary to teach something 
new every year. Those, therefore, who have formerly listened to my lectures on these subjects, 
and who now do me the honor to read this volume, will not be surprised to find, in many par- 
ticulars, changes in pathological views, and often in therapeutical teaching, from doctrines before 
inculcated. At the present day, for the first time in the history of the world, the obstetric de- 
partment seems to be assuming its proper position, as the highest branch of medicine, if its rank 
be graded by its importance to society, or by the intellectual culture and ability required, as 
compared with that demanded of the physician or the surgeon. A man may become eminent as 
a physician, and yet know very little of obstetrics; or he may be a successful and distinguished 
surgeon, and be quite ignorant of even the rudiments of obstetrics. But no one can be a really 
able obstetrician unless he be both physician and surgeon. And, as the greater includes the less, 
obstetrics should rank as the highest department of our profession."— From AxUltor's Preface. 



On Sea-sickness. 



By FORDYCE BARKER, M. D. 
1 vol., 16mo. 36 pp. Flexible Cloth, 75 cents. 

Reprinted from the New York Medical Journal. By reason of the great demand for the 
number of that journal containing the paper, it is now presented in book form, with such pre- 
scriptions added as the author has found useful in relieving the suffering from sea-sickness. 



4 D. Appleton <£ CoSs Medical Publications. 

BARNES. 

Obstetric Operations, including the Treatment 
of Hwmorrhage. 

By ROBERT BARNES, M. D., F. R. C. P., London, 

Obstetric Physician to and Lecturer on Midwifery and the Diseases of Women and Children at 
St. Thomas's Hospital; Examiner on Midwifery to the Royal College of Physicians and to 
the Royal College of Surgeons; formerly Obstetric Physician to the London Hospital, and 
late Physician to the Eastern Division of the Royal Maternity Charity. 

WITH ADDITIONS, by BENJAMIN F. DAWSON, M. D., 

Late Lecturer on Uterine Pathology in the Medical Department of the University of New 
York ; Assistant to the Clinical Professor of Diseases of Children in the College of Physicians 
and Surgeons, New York ; Physician for the Diseases of Children to the New York Dis- 
pensary ; Member of the New York Obstetrical Society, of the Medical Society of the 
County of New York, etc., etc. 

Second American Edition. 1 vol., 8vo. 503 pp. Cloth, $4.50. 

u Such a work as Dr. Barnes's was greatly needed. It is calculated to elevate the practice 
of the obstetric art in this country, and to be of great service to the practitioner/ 1 — Lancet. 

Bellevue and Charity Hospital Reports. 

The volume of Bellevue and Charity Hospital Reports 
for 1870, containing valuable contributions from 

ISAAC E. TAYLOR, M. D., AUSTIN FLINT, M. D., LEWIS A. SAYRE, M. D., WIL- 
LIAM A. HAMMOND, M. D., T. GAILLARD THOMAS, M. D., FRANK H. HAMIL- 
TON, M. D„ and others. 

1 vol., 8vo. Cloth, 84.00. 

41 These institutions are the most important, as regards accommodations for patients and 
variety of cases treated, of any on this continent, and are surpassed by but few in the world. 
The gentlemen connected with them are acknowledged to be among the first in their profession, 
and the volume is an important addition to the professional literature of this country." — Psydio- 
logical Journal. 

BENNET. 

Winter and Spring on the Shores of 

the Mediterranean ; or, the Riviera, Mentone, Italy, 
Corsica, Sicily, Algeria, Spain, and J3iarritz, as Win- 
ter Climates. 

By J. HENRY BENNET, M. D., 

Member of the Royal College of Physicians, London ; late Physician -Accoucheur to the Royal 
Free Hospital; Doctor of Medicine of the University of Paris; formerly Resident Physician 
to the Paris Hospital (ex-Interne des Hopitaux de Paris), etc. 

This work embodies the experience of ten winters and springs passed by Dr. Bennet on the 
shores of the Mediterranean, and contains much valuable information for physicians in relation 
to the health-restoring climate of the regions described. 

1 vol. 12mo. 621 pp. Cloth, $3.50. 

"Exceedingly readable, apart from its special purposes, and well illustrated." — Evening 
Commercial. 

u It has a more substantial value for the physician, perhaps, than for any other class or pro- 
fession. . . . We commend this book to our readers as a volume presenting two capital 
qualifications— it is at once entertaining and instructive." — N. Y. Medical Journal. 



D. Appleton & CoSs Medical Publications. 5 

BENNET. 

On the Treatment of Pulmonary Con- 

sumption, by Hygiene, Climate, and Medicine, in its 
Connection with Modern Doctrines. 

By JAMES HENRY BENNET, M. D., 

Member of the Royal College of Physicians, London ; Doctor of Medicine of the University ol 

Paris, etc., etc. 

1 vol., thin 8vo. Cloth, $1.50. 

An interesting and instructive work, written in the strong, clear, and lucid manner which 
appears in all the contributions of Dr. Bennet to medical or general literature. 

" We cordially commend this book to the attention of all, for its practical common-sense views 
of the nature and treatment of the scourge of all temperate climates, pulmonary consumption." 
— Detroit Review of Medicine. 

BILLROTH. 
General Surgical Pathology and The- 

rapeutics, in Fifty Lectures. A Text-booh for Students 

and Physicians. 

By Dr. THEODOR BILLROTH. 

Translated from the Fifth German Edition, with the special permission 

of the Author, by 

CHARLES E. HACKLEY, A. M., M. D., 

Surgeon to the New York Eye and Ear Infirmary; Physician to the New York Hospital; 
Fellow of the New York Academy of Medicine, etc. 

1 vol., 8vo. 714 pp., and 152 Woodcuts. Cloth, $5.00; Sheep, $6.00. 

Professor Theodor Billroth, one of the most noted authorities on Surgical Pathology, gives in 
this volume a complete resume of the existing state of knowledge ia this branch of medical 
science. The fact of this publication going through four editions in Germany, and having been 
translated into French, Italian, Russian, and Hungarian, should be some guarantee for its standing. 

" The want of a book in the English language, presenting in a concise form the views of the 
German pathologists, has long been felt; and we venture to say no book could more perfectly 
suppiy that want than the present volume. . . . We would strongly recommend it to all who 
take any interest in the progress of thought and observation in surgical pathology, and surgery." 
— The Lancet. 

'• We can assure our readers that they will consider neither money wasted in its purchase, 
nor time in its perusal." — The Medical Investigator. 

CARPENTER 
Principles of Mental Physiology, with 

their Applications to the Training and Discipline of the 
Mind and the Study of its Morbid Conditions. 

Br WM. B. CARPENTER, M. D., LL. D., F. R. S., F. L. S., F. G. S., 

Registrar of the University of London ; Corresponding Member of the Institute of France and 
of the American Philosophical Society, etc., etc. 

" Among the numerous eminent writers this country has produced, none are more deserving 
of praise for having attempted to apply the results of Physiological Research to the explanation 
of the mutual relations of the mind and body than Dr. Carpenter. To him belongs the merit of 
having scientifically studied and of having in many instances supplied a rational explanation of 
those phenomena which, under the names of mesmerism, spirit-rapping, electro-biology, and 
hypnotism, have attracted so large an amount of attention during the last twenty years. . . . We 
must conclude by recommending Dr. Carpenter's work to the members of our own profession as 
applying many facts, that have hitherto stood isolated, to the explanation of the functions of the 
brain and to psychological processes generally." — The Lancet. 



6 D. Appleton <b Co.'s Medical Publications. 



COMBE. 

The Management of Infancy, Physiologi- 
cal and Moral. Intended chiefly for the Use of 
Parents. 

By ANDREW COMBE, M. D. 
REVISED AND EDITED 

By Sir JAMES CLARK, K. C. B., M. D., F. R. S., 

Physician-in -ordinary to the Queen. 

First American from the Tenth London Edition. 1 vol., 12mo. 302 pp. 

Cloth, $1.50. 

"This excellent little book should he in the hand of every mother of a family; and, if some 
of our lady friends would master its contents, and either bring up their children by the light of 
its teachings, or communicate the truths it contains to the poor by whom they are surrounded, 
we are convinced that they would effect infinitely more good than by the distribution of any 
number of tracts whatever. . . . We consider this work to be one of the few popular medical 
treatises that any practitioner may recommend to his patients ; and, though, if its precepts are 
followed, he will probably lose a few guineas, he will not begrudge them if he sees his friend's 
children grow up healthy, active, strong, and both mentally and physically capable." — Tht 
Lancet. 

CHAUVEAU. 
The Comparative Anatomy of the 

Domesticated Animals. 

By A. CHAUVEAU, 

PEOFESSOE AT THE LYONS VETERINARY SCHOOL. 

Second edition, revised and enlarged, with the cooperation of S. ARLOING, 
late Principal of Anatomy at the Lyons Veterinary School ; Professor at the 
Toulouse Veterinary School. Translated and edited by GEORGE FLEMING, 
F. R. G. S., M. A. I., Veterinary Surgeon, Royal Engineers. 

1 vol., 8vo. Cloth. 957 pp., with 450 Illustrations. Price, $6.00. 



OPINIONS OF THE PRESS. 

" This is a valuable work, well conceived and well executed by the authors, MM. Chauveau 
and Arloing, and well translated by Mr. Fleming. It is rather surprising how few works exist, 
in any language, in which the anatomy of the commoner animals, domestic and otherwise, is 
given with any approach to detail. Systematic works there are in abundance, but. if the student 
be desirous of ascertaining any particular point, such as the position and branches of the 
pneumogastric or sympathetic nerves, or the homologue of a given muscle in several different 
animals, he may search all day ere he find it. The work before us appears to be well adapted to 
meet this difficulty. 

"The illustrations are very numerous, and Mr. Fleming has introduced a large number that 
are not contained in the original work. 

"Taking it altogether, the book is a very welcome addition to English literature, and great 
credit is due to Mr. Fleming for the excellence of the translation, and the many additional notes he 
has appended to Chauveau*s treatise." — Lancet (London). 

"The want of a text-book on the Comparative Anatomy of the Domesticated Animals has 
long been felt. . . . The descriptions of the text are illustrated and assisted by no less than 450 
excellent woodcuts. In a work which ranges over so vast a field of anatomical detail and de- 
scription, it is difficult to select any one portion for review, but our examination of it enables us 
to speak in high terms of its general excellence. . . . The care and attention with which hippot- 
omy has been cultivated on the Continent are illustrated by every page in M. Chauveau's work. 
—Medical Times and Gazette {London). 



D. Appleton & CoSs Medical Publications. 7 

DAVIS. 

Conservative Surgery, as exhibited in remedying 
some of the Mechanical Causes that operate injuriously 
both in Health and Disease. With Illustrations. 

By HENRY G. DAVIS, M. D., 

Member of the American Medical Association, etc., etc. 
1 vol., 8vo. 315 pp. Cloth. $3.00. 

The author has enjoyed rare facilities for the study and treatment of certain classes of disease, 
and the records here presented to the profession are the gradual accumulation of over thirty 
years' investigation. 

"Dr. Davis, bringing, as he does to his specialty, a great aptitude for the solution of mechani- 
cal prob'ems. takes a high rank as an orthopedic surgeon, and his very practical contribution to 
the literature of the subject is both valuable and opportune. We deem it worthy of a place in 
■every physician's library. The style is unpretending, but trenchant, graphic, and, best of all, 
quite intelligible. 11 — Medical Record. 

ECKER 
The Cerebral Convolutions of Man, 

represented according to Personal Investigations, espe- 
cially on their Development in the Foetus, and with ref 
erence to the Use of Physicians. 

By ALEXANDER ECKER, 

Professor of Anatomy and Comparative Anatomy in the University of Freiburg. 

Translated from the German by Robert T. Edes, M. D. 

1 vol., 8vo. 87 pp. $1.25. 

"The work of Prof. Ecker is noticeable principally for its succinctness and clearness, avoiding 
'long discussions on undecided points, and yet sufficiently furnished with references to make easy 
: its comparisons with the labors of others in the same direction. 

"Entire originality in descriptive anatomy is out of the question, but the facts verified by our 
author are here presented in a more intelligible manner than in any other easily-accessible work. 

"The knowledge to be derived from this work is not furnished by any other text-book in the 
English language/ 1 — Boston Medical and Surgical Journal, January 20, 1ST3. 

ELLIOT. 

ObstetncCliniC. A Practical Contribution to the Study 
of Obstetrics, and the Diseases of Women and Children. 
By the late GEOEGE T. ELLIOT, M. D., 

Late Professor of Obstetrics and Diseases of Women and Children in the Bellevue Hospital 
Medical College: Physician to Bellevue Hospital and to the New York Lying-in Asylum ; 
Consulting Physician to the Nursery and Child's Hospital ; Consulting Surgeon to the State 
Woman's Hospital : Corresponding Member of the Edinburgh Obstetrical Society and of the 
Royal Academy of Havana; Fellow of the N. Y. Academy of Medicine; Member of the 
County Medical Society, of the Pathological Society, etc., etc. 

1 vol., 8vo. 458 pp. Cloth, $4.50. 

This work is, in a measure, a resume of separate papers previously prepared by the late Dr. 
jEUiot; and contains, besides, a record of nearly two hundred important and difficult cases in mid- 
-wifery, selected from his own practice. It has met with a hearty reception, and has received tha 
"Vughest encomiums both in this country and in Europe. 



8 D. Appleton & Co.'s Medical Publications. 

FREY. 
The Histology and Histo-Chemistiy 

of Man. A Practical Treatise on the Elements of Com- 
position and Structure of the Human Body. 

By HEINKICH FREY, 

Professor of Medicine in Zurich. 

Translated from the Fourth German Edition, by Arthur E. J. Barker, 

Surgeon to the City of Dublin Hospital; Demonstrator of Anatomy, Eoyal College of Surgeons,. 
Ireland; Visiting Surgeon', Convalescent Home, Stillorgan; and revised by the Author.. 
With 680 Engravings. 

1 vol., 8vo. Cloth, $5.00 ; Sheep, $6.00. 

CONTENTS. 
The Elements of Composition and of Structure of the Body : Elements of Composition — Al- 
buminous or Protein Compounds, Haemoglobulin, Histogenic Derivatives of the Albuminous 
Substances or Albuminoids, the Fatty Acids and Fats, the Carbohydrates, Non-Nitrogenous- 
Acids, Nitrogenous Acids, Amides, Amido-Acids, and Organic Bases, Animal Coloring Matters, 
Cyanogen Compounds, Mineral Constituents ; Elements of Structure— the Cell, the Origin of the 
Eemaining Elements of Tissue ; the Tissues of the Body — Tissues composed of Simple Cells, with 
Fluid Intermediate Substance, Tissues composed of Simple Cells, with a small amount of Solid 
Intermediate Substance, Tissues belonging to the Connective-Substance Group, Tissues com- 
posed of Transformed, and, as a rule, Cohering Cells, with Homogeneous, Scanty, and more or less 
Solid Intermediate Substance, Composite Tissues: The Organs of the Body — Organs of the 
Vegetative Type, Organs of the Animal Group. 

FLIKT. 
Manual of Chemical Examination of 

the Urine in Disease. With Brief Directions for the 
Examination of the most Common Varieties of Urinary 
Calculi. 

By AUSTIN FLINT, Je., M.D., 

Professor of Physiology and Microscopy in the Bellevue Hospital Medical College : Fellow of the 
New York Academy of Medicine ; Member of the Medical Society of the County of New^ 
York ; Kesident Member of the Lyceum of Natural History in the City of New York, etc. 

Third Edition, revised and corrected. 1 vol., 12mo. 77 pp. Cloth, $1.00. 

The chief aim of this little work is to enable the busy practitioner to make for 
himself, rapidly and easily, all ordinary examinations of Urine ; to give him the 
benefit of the author's experience in eliminating little difficulties in the manipula- 
tions, and in reducing processes of analysis to the utmost simplicity that is con- 
sistent with accuracy. 

" We do not know of any work in English so complete and handy as the Manual now offered 
to the Profession by Dr. Flint, and the high scientific reputation of the author is a sufficient 
guarantee of the accuracy of all the directions given.''''— Journal of Applied Chemistry. 

"We can unhesitatingly recommend this Manual." — Psychological Journal. 

M Eminently practical. 1 '— Detroit Review of Medicine. 



D. Appleton & CoSs Medical Publications. 9 

FLINT. 

The Physiology of Man. Designed to rep- 
resent the Existing State of Physiological Science as 
applied to the Functions of the Human Body. 

By AUSTIN FLINT, Je., M. D., 

Professor of Physiology and Microscopy in the Bellevue Hospital Medical College, and in the 
Long Island College Hospital ; Fellow of the New York Academy of Medicine ; Microscopist 
to Bellevue Hospital 

New and thoroughly revised Edition. In Five Volumes. 8vo. Tinted Paper. 
Volume I. — The Blood ; Circulation; Respiration. 

8vo. 502 pp. Cloth, $4.50. 

" If the remaining portions of this work are compiled with the same care and 
accuracy, the whole may vie with any of those that have of late years been pro^ 
ducedinou-- 
cal Review. 



duced in our own or in foreign languages."— British and Foreign Medico- Chirurgi- 



"As a book of general information it will be found useful to the practitioner,, 
and, as a book of reference, invaluable in the hands of the anatomist and physi- 
ologist." — Dublin Quarterly Journal of Medical Science. 

" The complete work will prove a valuable addition to our systematic treatises 
on human physiology." — The lancet. 

" To those who desire to get in one volume a concise and clear, and at the 
same time sufficiently full resume of ' the existing state of physiological science ' 
we can heartily recommend Dr. Flint's work. Moreover, as a work of typographi- 
cal art it deserves a prominent place upon our library-shelves. Messrs. Appleton 
& Co. deserve the thanks of the profession for the very handsome style in which 
they issue medical works. They give us hope of a time when it will be very 
generally believed by publishers that physicians' eyes are worth saving."— Medi- 
co.' Gazette. 

Volume II. — Alimentation ; Digestion ; Absorption ; 
I/ynvph and Chyle. 

8vo. 556 pp. Cloth, $4.50. 

" The second instalment of this work fulfils all the expectations raised by the 
perusal of the first. . . . The author's explanations and deductions bear 
evidence of much careful reflection and study. . . . The entire work is one 
of rare interest. The author's style is as clear and concise as his method is 
studious, careful, and elaborate." — Philadelphia Inquirer. 

" We regard the two treatises already issued as the very best on human physi- 
ology which the English or any other language affords, and we recommend them 
with thorough confidence to students, practitioners, and laymen, as models of 
literary and scientific ability." — N. Y. Medical Journal. 

" We have found the style easy, lucid, and at the same time terse. The prac- 
tical and positive results of physiological investigation are succinctly stated, 
without, it would seem, extended discussion of disputed points." — Boston Medical 
and Surgical Journal. , 

" It is a volume which will be welcome to the advanced student, and as a 
work of reference." — The Lancet. 

" The leading subjects treated of are presented in distinct parts, each of which 
is designed to be an exhaustive essay on that to which it refers." — Western Jour- 
nal of Medicine. n 



10 D. Appleton & CoSs Medical Publications. 

Flint's Physiology. Volume Ul.— Secretion ; Ex- 
cretion; Ductless Glands ; Nutrition / Animal Heat ; 
Movements ; Voice and Speech. 

8vo. 526 pp. Cloth, $4.50. 

" Dr. Flint's reputation is sufficient to give a character to the book among the 
profession, where it will chiefly circulate, and many of the facts given have been 
verified by the author in his laboratory and in public demonstration." — Chicago 
Courier. 

" The author bestows judicious care and labor. Facts are selected with dis- 
crimination, theories critically examined, and conclusions enunciated with com- 
mendable clearness and precision." — American Journal of the Medical Sciences. 

Yolume IV. — The Nervous System. 

8vo. Cloth, $4.50. 

This volume embodies the results of exhaustive study, and of a long and 
laborious series of experiments, presented in a manner remarkable for its strength 
and clearness. No other department of physiology has so profound an interest 
for the modern and progressive physician as that pertaining to the nervous 
system. The diseases of this system are now engaging the study and attention 
of some of the greatest minds in the medical world, and in order to follow their 
brilliant discoveries and developments, especially in connection with the science 
of electrology, it is absolutely necessary to obtain a clear and settled knowledge 
of the anatomy and physiology of the nervous system. It is the design of this 
work to impart that knowledge free from the perplexing speculations and uncer- 
tainties that have no real value for the practical student of medicine. The 
author boldly tests every theory for himself, and asks his readers to accept noth- 
ing that is not capable of demonstration. The properties of the cerebro-spinal, 
nervous, and sympathetic systems are treated of in a manner at once lucid, 
thorough, and interesting. 

Although this volume is one, perhaps the most important one, of the author's 
admirable series in the Physiology of Man, it is nevertheless complete in itself, 
and may be safely pronounced indispensable to every physician who takes a pride 
and interest in the progress of medical science. 

Yolume Y. — Special Senses ; Generation. 

8vo. Cloth, $4.50. 

" The present volume completes the task, begun eleven years ago, of preparing 
a work, intended to represent the existing state of physiological science, as ap- 
plied to the functions of the human body. The kindly reception which the first 
four volumes have received has done much to sustain the author in an under- 
taking, the magnitude of which he has appreciated more and more as the work 
has progressed. 

" In the fifth and last volume, an attempt has been made to give a clear account 
of the physiology of the special senses and generation, a most difficult and delicate 
undertaking. . . . 

" Finally, as regards the last, as well as the former volumes, the author can 
only say that he has spared neither time nor labor in their preparation ; and the 
imperfections in their execution have beeu due to deficiency in ability and oppor- 
tunity. He indulges the hope, however, that he has written a book which may 
assist his fellow-workers, and interest, not only the student and practitioner of 
medicine, but some others who desire to keep pace with the progress of Natural 
Science. ' ' — Extracts from Preface. 



D. Appleton db Oo.'s Medical Publications. 



13 



HOFFMANN". 
Manual of Chemical Analysis, as applied 

to the Examination of Medicinal Chemicals and their 
Preparations. A Guide for the Determination of their 
Identity and Quality, and for the Detection of Impuri- 
ties and Adulterations. For the use of Pharmaceutists, 
Physicians, Druggists, and Manufacturing Chemists, and 
Pharmaceutical and Medical Students. 

By FRED. HOFFMANN, Phil. D. 

One vol., 8vo. Richly Illustrated. Cloth. Frice, S3. 

SPECIMEN OF ILLtTSTEATIONS. 




•Tins volume is a carefully -prepared -work, and well np to the existing state ofboth the science 
and art of modern pharmacy. It is a hook which will find its place in every medical and phar- 
maceutical laboratory and 'library, and is a safe and instructive puide to medical students and 
practitioners of medicine.' 1 — American Journal of Science and Arts. 

In America this work has already met with p-eneral and unqualified approval : and in Europe 
is now bein? welcomed as one of the best and most important additions to modern pharmaceu- 
tical literature. 

Send for descriptive circular. Address 

D. APPLETON & CO., 549 & 551 Broadway, N. Y. City. 



34 -K Appleton c5 CVs Medical Publications. 

HOLLAND. 
Recollections of Past Life, 

By SIR HENRY HOLLAND, Bart, M. D., F. R. S., K. C. B., etc., 
President of the Royal Institution of Great Britain, Physician-in-Ordinary to the Queen, 

etc., etc. 

1 vol., 12mo, 351 pp. Price, Cloth, $2.00. 

A very entertaining and instructive narrative, partaking somewhat of the nature of 
autobiography and yet distinct from it, in this, that its chief object, as alleged by the 
writer, is not so much to recount the events of his own life, as to perform the office of 
chronicler for others with whom he came in contact and was long associated. 

The "Life of Sir Henry Holland " is one to be recollected, and he has not erred in giv- 
ing an outline ot it to the public."— The Lancet. 

14 His memory was — is, we may say, for he is still alive and in possession of all hia 
faculties— stored with recollections of the most eminent men and women of this cen- 
tury. ... A life extending over a period of eighty-four years, and passed in the most 
active manner, in the midst of the best society, which the world has to offer, must neces- 
sarily be full of singular interest; and Sir Henry Holland has fortunately not waited umil 
his memory lost its freshness before recalling some of the incidents in it."— The New 
York Times. 

HOWE. 
Emergencies, and How to Treat Them. 

The Etiology, Pathology, and Treatment of Accidents, 
Diseases, and Cases of Poisoning, which demand 
Prompt Attention. Designed for Students and Prac- 
titioners of Medicine. 

By JOSEPH W. HOWE, M.D., 

Clinical Professor of Surgery in the Medical Department of the University of New York 

Visiting Surgeon to Charity Hospital; Fellow of the New York Academy 

of Medicine, etc., etc. 

1 vol., 8vo. Cloth, $3.00. 

" This work has a taking title, and was written by a gentlemen of acknowledged ability, tc 
fill a void in the profession. ... To the general practitioner in towns, villages, and in the 
country, where the aid and moral support of a consultation cannot be availed of, this volume 
will he recognized as a valuable help. We commend it to the profession.— Cincinnati Lance t 
and Observer. 1 . .... , , 

" This work is certainly novel in character, and its usefulness and acceptability are as marked 
as its novelty. . . . The book is confidently recommended."— Richmond and Louisville Med- 
ical Journal. .,...«» 

" This volume is a practical illustration of the positive side of the physician's life, a constant 
reminder of what he is to do in the sudden emergencies which frequently occur in practice. 
. . . The author wastes no words, but devotes himself to the description of each disease as if 
the patient were under his hands. Because it is a good book we recommend it most heartily to 
the profession." — Boston Medical and Surgical Journal. 

" This work bears evidence of a thorough practical acquaintance with the different branches 
of the profession. The author seems to possess a peculiar aptitude for imparting instruction 
as well as for simplifying tedious details. ... A careful perusal will amply repay the student 
and practitioner.'' —New York Medical Journal." „ w , _ , _, _ T 7 . , 

"This is the best work of the kind we have ever seen:'— New York Journal of Paycholog'ccal 
Medicine. 



D. Appleton <b Co.'s Medical Publications. 15 

HOWE. 
The Breath, and the Diseases which give 

it a Fetid Odor. With Directions for Treatment. 
By JOSEPH W. HOWE, M. D., 

Author of " Emergencies," " Winter Homes, 1 ' etc ; Clinical Professor of Surgery in the Medical 
Department of the University of New York ; Visiting Surgeon to Charity and St. Francis 
Hospitals; Fellow of the New York Academy of Medicine, etc. 

"It is somewhat remarkable that the subject of fetid breath, which occasions so much annoy- 
ance. . . . should have attracted so little attention from authors and investigators. Hence a 
thoroughly scientific exposition of the whole subject, such as Dr. Howe has given us, has long 
been a desideratum. . . . This little volume well deserves the attention of physicians, to whom 
we commend it most highly." 1 — Chicago Medical Journal. 

"... To any one suffering from the affection, either in his own person or in that of his inti- 
mate acquaintances, we can commend this volume as containing all that is known concerning the 
subject, set forth in a pleasant style." — Philadelphia Medical Times. 

" This little work is on a subject that has heretofore been almost entirely ignored by medical 
authors, yet its importance is well known by every practitioner. . . . The author gives a succinct 
account of the diseased conditions in which a fetid breath is an important symptom, with his 
method of treatment. "We consider the work a real addition to medical literature." — Cincinnati 
Medical Journal. 

HUXLEY AND YOUMANS. 
The Elements of Physiology and Hy- 

giene. With Numerous Illustrations. 

By THOMAS H. HUXLEY, LL. D., F.K.S., and 

WILLIAM JAY YOUMANS, M. D. 

New and Revised Edition. 1 vol., 12mo. 420 pp. SI. 75. 

A text-book for educational institutions, and a valuable elementary work for students of medi- 
cine. The greater portion is from the pen of Professor Huxley, adapted by Dr. Toumans to the 
circumstances and requirements of American education. The eminent claim of Professor Hux- 
ley's "Elementary Physiology" is, tbat, while up to the times, it is trustworthy in its presenta- 
tion of the subject ; while rejecting discredited doctrines and doubtful speculations, it embodies 
the latest results that are established, and represents the present actual state of physiological 
knowledge. 

"A valuable contribution to anatomical and physiological science." — Religious Telescope. 

"A clear and well arranged work, embracing the latest discoveries and accepted theories." — 
Buffalo Commercial. 

"Teeming with information concerning the human physical economy."— Evening Journal. 

HUXLEY. 

The Anatomy of Vertebrated Animals. 

By THOMAS HENEY HUXLEY, LL.D., F. E. S., 

Author of " Man's Place in Nature," B On the Origin of Species," " Lay Sermons and Addresses," 

etc. 

1 vol., 12mo. Cloth, $2.50. 

The former works of Prof. Huxley leave no room for doubt as to the importance and value of 
his new volume. It is one which will be very acceptable to all who are interested in the subject 
of which it treats. 

"This long-expected work will be cordially welcomed by all students and teachers of Com- 
parative Anatomy as a compendious, reliable, and, notwithstanding its small dimensions, most 
comprehensive guide on the subject of which it treats. To praise or to criticise the work of so 
accomplished a master of his favorite science would be equally out of place. It is enough to say 
that it realizes, in a remarkable degree, the anticipations which have been formed of it; and that 
it presents an extraordinary combination of wide, general views, with the clear, accurate, and 
succinct statement of a prodigious number of individual facts."— Nature. 



16 D. Appleton & Co.'s Medical Publications. 

JOHNSON. 
The Chemistry of Common Life. 

Illustrated with numerous Wood Engravings. 
By JAMES F. JOHNSON, M. A., F. R. S., F. G. S., etc., etc., 

Author of "Lectures on Agricultural Chemistry and Geology," "A Catechism of Agricultural 
Chemistry and Geology," etc. 

2 vols., 12mo. Cloth, $3.00. 
It has been the object of the author in this work to exhibit the 
present condition of chemical knowledge, and of matured scientific 
opinion, upon the subjects to which it is devoted. The reader will not 
be surprised, therefore, should he find in it some things which differ 
from what is to be found in other popular works already in his hands or 
on the shelves of his library. 

LETTERMAN. 
Medical Recollections of the Army of 

the Potomac. 

By JONATHAN LETTERMAN, M. D., 

Late Surgeon U. S. A., and Medical Director of the Army of the Potomac. 
1 vol., 8vo. 194 pp. Cloth, SI. 00. 
" This account of the medical department of the Army of the Poto- 
mac has been prepared, amid pressing engagements, in the hope that 
the labors of the medical officers of that army may be known to an in- 
telligent people, with whom to know is to appreciate ; and as an affec 
tionate tribute to many, long my zealous and efficient colleagues, who, 
in days of trial and danger, which have passed, let us hope never to re- 
turn, evinced their devotion to their country and to the cause of hu- 
manity, without hope of promotion or expectation of reward." — Preface. 

" We venture to assert that but few who open this volume of medical annals, 
pregnant as they are with instruction, will care to do otherwise than finish them 
at a sitting." — Medical Record. 

" A graceful and affectionate tribute." — N. 7. Medical Journal. 

LEWES. 
The Physiology of Common Life. 

By GEORGE HENRY LEWES, 

Author of "Seaside Studies," "Life of Goethe," etc. 

2 vols., 12mo. Cloth, $3.00. 

The object of this work differs from that of all others on popular 

science in its attempt to meet the wants of the student, while meeting 

those of the general reader, who is supposed to be wholly unacquainted 

with anatomy and physiology. 



D. Appleton & CoSs Medical Publication*. 17 

MATJDSLEY. 
The Physiology and Pathology of the 

Mind. 

By HENRY MATJDSLEY, M. D., London, 

Physician to the "West London Hospital ; Honorary Member of the Medico-Psychological Society 
of Paris ; formerly Eesident Physician of the Manchester Royal Lunatic Hospital, etc 

1 vol., 8vo. 442 pp. Cloth, $3.00. 

This work aims, in the first place, to treat of mental phenomena from 
a physiological rather than from a metaphysical point of view ; and, 
secondly, to bring the manifold instructive instances presented by the 
unsonnd mind to bear npon the interpretation of the obscure problems 
of mental science. 

" Dr. Maudsley has had the courage to undertake, and the skill to execute, 
what is, at least in English, an original enterprise." — London Saturday Review. 

" It is so full of sensible reflections and sound truths that their wide dissemi- 
nation could not but be of benefit to all thinking persons." — PsychologicalJoumal. 

" Unquestionably one of the ablest and most important works on the subject 
of which it treats that has ever appeared, and does credit to his philosophical 
acumen and accurate observation." — Medical Record. 

" We lay down the book with admiration, and we commend it most earnestly 
to our readers as a work of extraordinary merit and originality— one of those 
productions that are evolved only occasionally in the lapse of years, and that 
serve to mark actual and very decided advances in knowledge and science." — 
N. Y. Medical Journal. 



Body 



atlQ. IVliriQ '. An Inquiry into their Con- 
nection and Mutual Influence^ especially in reference 
to Mental Disorders ; an enlarged and revised edition 
to which are added Psychological Essays. 

By HEKRY MATJDSLEY, M. D., London, 

Fellow of the Eoyal College of Physicians ; Professor of Medical Jurisprudence in University Col- 
lege, London ; President-elect of the Medico-Psychol«gical Association ; Honorary Member of 
the Medico-Psychological Society of Paris, of the Imperial Society of Physicians of Vienna, 
and of the Society for the Promotion of Psychiatry and Forensic Psychology of Vienna • 
formerly Eesident Physician of the Manchester Royal Lunatic Asylum, etc., etc. 

1 vol., 12mo. 155 pp. Cloth, $1.00. 
The general plan of this work may be described as being to bring 
man, both in his physical and mental relations, as much as possible with- 
in the scope of scientific inquiry. 

" A representative work, which every one must study who desires to know 
what is doing in the way of real progress, and not mere chatter, about mental 
physiology and pathology."— The Lancet. 

"It distinctly marks a step in the. progress of scientific psychology."— Tht 
Practitioner. 



18 D. Applet on & CoSs Medical Publications. 

MAUDSLEY. 
Responsibility in Mental Diseases. 

By HENRY MAUDSLEY, M. D., 

Fellow of the Koyal College of Physicians, Professor of Medical Jurisprudence in University 
College, London, etc., etc. Author of " Body and Mind," " Physiology and Pathology of the 
Nervous System." 

1 vol., 12mo. 313 pp. Cloth, $1.50. 

"This book is a compact presentation of those facts and principles which re- 
quire to be taken into account in estimating human responsibility — not legal 
responsibility merely, but responsibility for conduct in the family, the school, and 
all phases of social relation in which obligation enters as an element. The work 
is new in plan, and was written to supply a widely-felt want which has not 
hitherto been met." — The Popular Science Monthly. 



MARKOE. 
A Treatise on Diseases of the Bones. 

By THOMAS M. MARKOE, M. D., 

Professor of Surgery in the College of Physicians and Surgeons, New York, etc 

WITH NTTMEKOUS ILLUSTRATIONS. 
1 vol., 8vo. Cloth, $4.50. 

This valuable work is a treatise on Diseases of the Bones, embracing their 
structural changes as affected by disease, their clinical history and treatment, in- 
eluding also an account of the various tumors which grow in or upon them. None 
of the injuries of bone are included in its scope, and no joint diseases, excepting 
where the condition of the bone is a prime factor in the problem of disease. As 
the work of an eminent surgeon of large and varied experience, it may be regarded 
as the best on the subject, and a valuable contribution to medical literature. 

" The book which I now offer to my professional brethren contains the substance of the 
lectures which I have delivered during the past twelve years at the college. ... I have followed 
the leadings of my own studies and observations, dwelling more on those branches where I had 
seen and studied most, and perhaps too much neglecting others where my own experience was 
more barren, and therefore to me less interesting. I have endeavored, however, to make up the 
deficiencies of my own knowledge by the free use of the materials scattered so richly through 
our periodical literature, which scattered leaves it is the right and the duty of the systematic 
writer to collect and to embody in any account he may offer of the state of a science at any given 
period." — Extract from Author's Preface. 



D. Appleton & CoSs Medical Publications. 19 

MEYER. 
Electricity in its Relations to Practical 

Medicine. 

By De. MORITZ MEYER, 

Eoyal Counsellor of Health, etc 

Translated from the Third German Edition, with Notes and Additions. 
A New and Revised Edition, 

By WILLIAM A. HAMMOND, M. D., 

Professor of Diseases of the Mind and Nervous System, and of Clinical Medicine, in the Bellevue 
Hospital Medical College; Vice-President of the Academy of Mental Science^ National 
Institute of Letters, Arts, and Sciences ; late Surgeon-General U. S. A., etc. 

1 vol., 8vo. 497 pp. Cloth, $4.50. 

" It is the duty of every physician to study the action of electricity, 
to become acquainted with its value in therapeutics, and to follow the 
improvements that are being made in the apparatus for its application in 
medicine, that he may be able to choose the one best adapted to the 
treatment of individual cases, and to test a remedy fairly and without 
prejudice, which already, especially in nervous diseases, has been used 
with the best results, and which promises to yield an abundant harvest 
in a still broader domain." — From Author's Preface. 

SPECIMEN OF ILLUSTRATIONS. 




Saxton-Ettlnghausen Apparatus. 

" Those who do not read German are under great obligations to William A 
Hammond, who has given them not only an excellent translation of a most^ ex- 
cellent work, but has given us much valuable information and many suggestions: 
from his own personal experience." — Medical Record. 

" Dr. Moritz Meyer, of Berlin, has been for more than twenty years a laborious 
and conscientious student of the application of electricity to practical medicine, 
and the results of his labors are given in this volume. Dr. Hammond, in making 
a translation of the third German edition, has done a real service to the profession 
of this country and of Great Britain. Plainly and concisely written, and simply 
and clearly arranged, it contains just what the physician wants to know on the 
subject." — N. Y. Medical Journal. 

" It is destined to fill a want long felt by physicians in this country."— Journal 
of Obstetrics 



20 I>. Appleton db CoSs Medical Publications. 

NIEMEYER 
A Text-Book of Practical Medicine. 

With Particular Reference to Physiology and Patho- 
logical Anatomy. 

By the late Dr. FELIX VON NIEMEYER, 

Profetsor of Pathology and Therapeutics ; Director of the Medical Clinic of the University of 

Tubingen. 

Translated from the Eighth German Edition, by special permission of 

the Author, 

By GEORGE H. HUMPHREYS, M. D., 

Late jne of the Physicians to the Bureau of Medical and Surgical Belief at Bellevue Hospital foi 
the Out-door Poor; Fellow of the New York Academy of Medicine, etc., 

and 

CHARLES E. HACKLEY, M. D., 

One of the Physicians to the New York Hospital ; one of the Surgeons to the New York Ey« 
and Ear Infirmary ; Fellow of the New York Academy of Medicine, etc. 

Eevised Edition. 2 vols., 8vo. 1,528 pp. Cloth, $9.00 ; Sheep, $11.00. 

The author undertakes, first, to give a picture of disease which shall 
be as lifelike and faithful to nature as possible, instead of being a mere 
theoretical scheme ; secondly, so to utilize the more recent advances 
of pathological anatomy, physiology, and physiological chemistry, as to 
furnish a clearer insight into the various processes of disease. 

The work has met with the most flattering reception and deserved 
success ; has been adopted as a text-book in many of the medical colleges 
both in this country and in Europe; and has received the very highest 
encomiums from the medical and secular press. 

"It is comprehensive and concise, and is characterized by clearness and 
Originality." — Dublin Quarterly Journal of Medicine. 

" Its author is learned in medical literature ; he has arranged his materials 
with care and judgment, and has thought over them." — TJie Lancet. 

"As a full, systematic, and thoroughly practical guide for the student and 
physician, it is not excelled by any similar treatise in any language." — Appletons 1 
Journal. 

" The author is an accomplished pathologist and practical physician ; he is not 
only capable of appreciating the new discoveries, which during the last ten years 
have been unusually numerous and important in scientific and practical medicine, 
but, by his clinical experience, he can put these new views to a practical test, and 
give judgment regarding them." — Edinburgh Medical Journal. 

" From its general excellence, we are disposed to think that it will soon take 
its place among the recognized text-books." — American Quarterly Journal of 
Medical Sciences. 

" The first inquiry in this country regarding a German book generally is, ' la 
it a work of practical value ? " Without stopping to consider the justness of the 
American idea of the ' practical,' we can unhesitatingly answer, ' It is ! ' " — New 
York Medical Journal. 

" The author has the power of sifting the tares from the wheat — a matter of 
the greatest importance in a text-book for students." — British Medical Journal. 

" Whatever exalted opinion our countrymen may have of the author's talents 
cf observation and his practical good sense, his text-book will not disappoint 
them, while those who are so unfortunate as to know him only by name, have in 
6 tore a rich treat." — New York Medical Record, 



D. Appleton & CoSs Medical Publications. 21 

NEUMANN. 
Hand-Book of Skin Diseases. 

By Dr. ISIDOR NEUMANN, 
Lecturer on Skin Diseases in the Royal University of Vienna. 

Translated from advanced sheets of the second edition, furnished by the 
Author ; with Notes, 

By LUCIUS D. BULKLEY, A. M., M. D., 

Surgeon to the New York Dispensary, Department of Venereal and Skin Diseases ; Assist- 
ant to the Skin Clinic of the College of Physicians and Surgeons, New York; Mem- 
ber of the New York Dermatological Society, etc., etc. 

1 vol., 8vo. About 450 pages and 66 Woodcuts. Cloth, $4.00. 

SPECIMEN OF IliUSTEATIONS. 




Section of skin from a bald head. 

Prof. Neumann ranks second only to Hebra, whose assistant he was for many year? 
and his work may be considered as a fair exponent of the German practice of Dermatolo- 
gy. The book is abundantly illustrated with plates of the histology and pathology of the 
skin. The translator has endeavored, by means of notes from French, English, and Ameri- 
can sources, to make the work valuable to the student as well as to the practitioner. 

" It is a work which I shall heartily recommend to my class of students at the Univer- 
sity of Pennsylvania, and one which I feel sure will do much toward enlightening the pro- 
fession on this subject." — Louis A. Zhikring. 

" I know it to be a good book, and I am sure that it is well translated; and it is inter- 
esting to find it illustrated by references to the views of co-laborers in the same field."— 
Erasmus Wilson. 

" So complete as to render it a most useful book of reference."—? 7 . McCatt Anderson. 

M There certainly is no work extant which deals so thoroughly with the Pathological 
Anatomy of the Skin as does this hand-book."— .V. Y. Medical Record. 

"The original notes by Dr. Bnlkley are very practical, and are an important adjunct to 
the text. ... I anticipate for it a wide circulation."— Silas Durkee, Boston. 

" I have already twice expressed my favorable opinion of the book in print, and am 
glad that it is given to the public at last." — James C. White, Boston. 

"More than two years ago we noticed Dr. Neumann's admirable work in its original 
shape ; and we are therefore absolved from the necessity of saying more than to repeat 
our strong recommendation of it to English readers."— Practitioner. 



22 J). Appleton & CoSs Medical Publications. 

NEFTEL. 

GalvanO-TherapeutlCS. The Physiological and 
Therapeutical Action of the Galvanic Current upon 
the Acoustic, Optic, Sympathetic, and Pneumogastric 

Nerves. 

By WILLIAM B. NEFTEL. 
1 vol., 12mo. 161 pp. Cloth, $1.50. 

This book has been published at the request of several aural sur- 
geons and other professional gentlemen, and is a valuable treatise on 
the subjects of which it treats. Its author, formerly visiting physician 
to the largest hospital of St. Petersburg, has had the very best facili- 
ties for investigation. 

" This little work shows, as far as it goes, full knowledge of what has been 
done on the subjects treated of, and the author's practical acquaintance with 
them." — New York Medical Journal. 

" Those who use electricity should get this work, and those who do not 
should peruse it to learn that there is one more therapeutical agent that they 
could and should possess." — The Medical Investigator. 

NIGHTINGALE. 
Notes Oil Nursing: What it is, and what it is not. 

By FLORENCE NIGHTINGALE. ' 
1 vol., 12mo. 140 pp. Cloth, 75 cents. 
Every-day sanitary knowledge, or the knowledge of nursing, or, in 
other words, of how to put the constitution in such a state as that it will 
have no disease or that it can recover from disease, takes a higher place. 
It is recognized as the knowledge which every one ought to have — dis- 
tinct from medical knowledge, which only a profession can have. 

PEREIRA. 

Dr. Pereira's Elements of Materia 

Medica and Therapeutics. Abridged and adapted 
for the Use of Medical and Pharmaceutical Practi- 
tioners and Students, and comprising all the Medi- 
cines of the Uritish Pharmacopoeia, with such others 
as are frequently ordered in Prescriptions, or re- 
quired by the Physician. 

Edited by KOBERT BENTLEY and THEOPHILUS REDWOOD. 

New Edition. Brought down to 1872. 1 vol., Eoyal 8vo. Cloth, $7.00 ; 
Sheep, $8.00. 



D. Appleton & Co. 's Medical Publications. 23 

PEASLEE. 

Ovarian Tumors ; Their Pathology, Diagnosis, 
and Treatment, with reference especially to Ovariotomy. 
By E. E. PEASLEE, M. D., 

Professor of Diseases of Women in Dartmouth College; one of the Consulting Physicians to 
the New York State Woman's Hospital ; formerly Professor of Obstetrics and Diseases of 
"Women in the New York Medical College ; Corresponding Member of the Obstetrical 
Society of Berlin, etc. 

1 vol., 8vo. Illustrated with many Woodcuts, and a Steel Engraving of Dr. 
E. McDowell, the " Father of Ovariotomy." Price, Cloth, $5.00. 

This valuable work, embracing the results of many years of successful experience in the 
department of which it treats, will prove most acceptable to the entire profession ; while the 
high standing of the author and his knowledge of the subject combine to make the book the 
best in the language. It is divided into two parts : the first treating of Ovarian Tumors, their 
anatomy, pathology, diagnosis, and treatment, except by extirpation ; the second of Ovariot- 
omy, its history and statistics, and of the operation. Fully illustrated, and abounding with 
information the result of a prolonged study of the subject, the work should be in the hands of 
every physician in the. country. 

The following are some of the opinions of the press, at home and abroad, of this great 
work, which has been justly styled, by an eminent critic, " the most complete medical mono- 
graph on a practical subject ever produced in this country.' 1 '' 

"His opinions upon what others have advised are clearly set forth, and are as interesting 
and important as are the propositions he has himself to advance ; while there are a freshness, 
a vigor, an authority about his writing, which great practical knowledge alone can confer." — 
The Lancet. 

"Both Wells's and Peaslee's works will be received with the respect due to the great repu- 
tation and skill of their authors. Both exist not only as masters of their art, but as clear and 
graceful writers. In either work the student and practitioner will find the fruits of rich expe- 
rience, of earnest thought, and of steady, well-balanced judgment. As England is proud of 
Wells, so may America well be proud of 'Peaslee, and the great world of science may be proud 
of both. 1 '— British Medical Journal. 

" This is an excellent work, and does great credit to the industry, ability, science, and 
learning of Dr. Peaslee. Few works issue from the medical press so complete, so exhaustive- 
ly learned, so imbued with a practical tone, without losing other substantial good qualities." 
— Edinburgh Medical Journal. 

" In closing our review of this work, we cannot avoid again expressing our appreciation of 
the thorough study, the careful and honest statements, and candid spirit, which characterize it. 
For the use of the student we should give the preference to Dr. Peaslee's work, not only 
from its completeness, but from its more methodical arrangement.' 1 '' — American Journal 
of Medical Sciences. 

" Dr. Peaslee brings to the work a thoroughness of study, a familiarity with the whole 
field of histology, physiology, pathology, and practical gynaecology, not excelled, perhaps, by 
those of any man who ever performs the operation." — Medical Record. 

" If we were to select a single word to express what we regard as the highest excellence of 
this book, it would be its thoroughness." — New York Medical Journal. 

" We deem its careful perusal indispensable to all who would treat ovarian tumors with a 
good conscience." — American Journal of Obstetrics. 

" It shows prodigal industry, and embodies within its five hundred and odd pages pretty 
much all that seems worth knowing on the subject of ovarian diseases." — Philadelphia Medi- 
cal Times. 

" Great thoroughness is shown in Dr. Peaslee's treatment of all the details of this very ad- 
mirable work." — Boston Medical and Surgical Journal. 

"It is a necessity to every surgeon who expects to treat this disease."— Leavenworth 
Medical Herald. 

" Indispensable to the American student of gynaecology."— Pacific Medical and Surgical 
Journal. 

" There is not a doubtful point that could occur to any one that is not explained and an- 
swered in the most satisfactory manner." — Virginia Clinical Record. 

" The work is one the profession should prize ; one that every earnest practitioner should 
possess."— Georgia Medical Companion. 

"Dr. Peaslee has achieved a success, and the work is one which no practical surgeon can 
afford to be without." — Medical Investigator. 



24 JD. Appleton & Co.'s Medical Publications. 

SAYRE. 
A Practical Manual on the Treatment 

of Club-Mot. 

By LEWIS A. SAYKE, M.D., 

Professor of Orthopedic Surgery in Bellevue Hospital Medical College ; SurgeoD to Bellevue and 
Charity Hospitals, etc. 

1 vol., 12mo. New and Enlarged Edition. Cloth, $1.00. 

"The object of this work is to convey, in as concise a manner as possible, all the practical in- 
formation and instruction necessary to enable the general practitioner to apply that plan of treat- 
ment which has been so successful in my own hands." — Preface. 

" The book will very well satisfy the wants of the majority of general practitioners, for whose 
use, as stated, it is intended." — New York Medical Journal. 

SMITH. 

On Foods. 

By EDWARD SMITH, M.D., LL. B., F. K. S., 

Fellow of the Eoyal College of Physicians of London, etc., etc., 
1 vol., 12mo. Cloth. Price, $1.75. 

Since the issue of the author's work on "Practical Dietary," he has felt the want of another, 
which would embrace all the generally-known and less-known foods, and contain the latest scien- 
tific knowledge respecting them. The present volume is intended to meet this want, and will be 
found useful for reference, to both scientific and general readers. The author extends the ordi- 
nary view of foods, and includes water and air, since they are important both in their food and 
and sanitary aspects. 

STEINER 
Compendium of Children's Diseases. 

A Sand-book for Practitioners and Students. 
By Dr. .JOHAKN" STEIKER, 

Professor of the Diseases of Children in the University of Prague, and Physician to the Francis- 
Joseph Hospital for Sick Children. 

Translated from the Second German Edition by Lawson Tait, F. It. C. S., 

Surgeon to the Birmingham Hospital for "Women ; Consulting Surgeon to the West Bromwich 
Hospital; Lecturer on Physiology at the Midland Institute. 

1 vol., 8vo. Cloth, $3.50. 
TRANSLATOR'S PREFACE. 

Dr. Steiner's book has met with such marked success in Germany that a second edition has 
already appeared, a circumstance which has delayed the appearance of its English form, in order 
that I might be able to give his additions and corrections. 

In Germany the use of the metric system has not yet entirely superseded the local measures ; 
but it is rapidly doing so, as in England. I have, therefore, rendered all thermometric observa- 
tions in the Centigrade scale, and all measurements in centi- and millimetres. 

I have added as an Appendix the " Eules for Management of Infants ,1 which have been issued 
by the staff of the Birmingham Sick Children's Hospital, because I think that they have set an 
example by freely distributing these rules among the poor for which they cannot be sufficiently 
commended, and which it would be wise for other sick children's hospitals to follow. 

I have also added a few notes, chiefly, of course, relating to the surgical ailments of children. 

BruanNGHAM, October, 18T4. LAWSON TAIT. 



D. Appleton & CoSs Medical Publications, 25 

STROUD. 
The Physical Cause of the Death of 

Christ, and its Relations to the Principles and Practice 

of Christianity. 

By WILLIAM STROUD, M. D. 

With, a Letter on the Subject, by Sir James Y. Simpson, Bart., M. D. 

lvol., 12mo. 422 pp. Cloth, $2.00. 

This important and remarkable book is, in its own place, a masterpiece, and will be considered 
as a standard work for many years to come. 

"The principal point insisted on is, that the death of Christ was caused by rupture or lacera- 
tion of the heart. Sir James Y. Simpson, who had read the author's treatise and various com- 
ments on it, expressed himself very positively in favor of the views maintained by Dr. Stroud."' 
—Psyc/tological Journal. 

SIMPSOK 
The Posthumous Works of Sir James 

Young Simpson, Bart., M. D. In Three Volumes. 

"Volume I. — Selected Obstetrical and Gynaecological Works of Sir James Y. Simpson > 
Bart., M. D., D. C. L.. late Professor of Midwifery in the University of Edinburgh. Contain- 
ing the substance of his Lectures on Midwifery. Edited by J. Watt Black. A. M.. M. D. r 
Member of the Royal College of Physicians. London ; Physician- Accoucheur to Charing- 
Cross Hospital, London : and Lecturer on Midwifery and Diseases of Women and Children 
in the Hospital School of Medicine. 

1 vol., 8vo. 852 pp. Cloth, $3.00. 
This volume contains all the more important contributions of Sir James T. Simpson to thft 
study of obstetrics and diseases of Women, with the exception of his clinical lectures on the latter 
subject, which will shortly appear in a separate volume. This first volume contains many of the- 
papers reprinted from his Obstetric Memoirs and Contributions, and also his Lecture Notes, now 
published for the first time, containing the substance of the practical part of his course of mid- 
wifery. It is a volume of great interest to the profession, and. a fitting memorial of its renowned 
and talented author. 

" To many of our readers, doubtless, the chief of the papers it contains are familiar. To 
others, although probably they may be aware that Sir James Simpson has written on the sub- 
jects, the papers themselves will be new and fresh. To the first class we would recommend thi3- 
edition of Sir James Simpson's works, as a valuable volume of reference ; to the latter, as a collec- 
tion of the works of a great master and improver of his art, the study of which cannot fail to makfr 
them better prepared to meet and overcome its difficulties." — Medical Times and Gazette. 

Volume II. — Anaesthesia, Hi spitalism, etc. Edited by Sir Walter Simpson, Bart. 
1 vol., 8vo. 560 pp. Cloth, $3.00. 

" We say of this, as of the first volume, that it should find a place on the table of every prac- 
titioner ; for, though it is patchwork, each piece may be picked out and studied with pleasure and 
profit."— TV/g Lancet {London). 

Volume III. — The Diseases of Women. Edited by Alex. Simpson, M. D., Professor 
of Midwifery in the University of Edinburgh. 

1 vol., 8vo. Cloth, $3.00. 

One of the best works on the subject extant. Of inestimable value to every physician. 

SWETT. 
A Treatise on the Diseases of the Chest. 

Being a Course of Lectures delivered at the New York 

Hospital. 

By JOHN" A. SWETT, M. D., 

Professor of the Institutes and Practice of Medicine in the New York University ; Physician to- 
the New York Hospital ; Member of the New York Pathological Society. 

1 vol., 8vo. 587 pp. $3.50. 

Embodied in this volume of lectures is the experience of ten years in hospital and private 
practice. 



26 D. Appleton <£• CoSs Medical Publications. 

SCHROEDER 
A Manual of Midwifery, including the 

Pathology of Pregnancy and the Puerperal State. 
By Dr. KARL SCHROEDER. 

Professor of Midwifery and Director of the Lying-in Institution in the University of Erlangen. 
Translated from the Third German Edition, 

By CHAS. H. CARTER, B. A., M. D., B. S. Lond., 

Member of the Eoyal College of Physicians, London, and Physician Accoucheur to St George's, 
Hanover Square, Dispensary. 

With Twenty-six Engravings on Wood. 1 vol., 8vo. Cloth. 

" The translator feels that no apology is needed in offering to the profession a translation 
of Schroeder's Manual of Midwifery. The work is well known in Germany and extensively 
used as a text-book ; it has already reached a third edition within the short space i two years, 
and it is hoped that the present translation will meet the want, long felt in thic country, of a 
manual of midwifery embracing the latest scientific researches on the subject, 

TILT. 

A Hand-Book of Uterine Therapeu- 

tics and, of Diseases of Women. 

By EDWARD JOIIN TILT, M. D., 

Member of the Eoyal College of Physicians ; Consulting Physician to the Farringdon General 
Dispensary ; Fellow of the Eoyal Medical and Chirurgical Society, and of several British, 
and foreign societies. 

1 vol., 8vo. 345 pp. Cloth, 83.50. 

Second American edition, thoroughly revised and amended. 

" In giving the result of his labors to the profession the author has done a "Teat work. Our 
readers will find its pages very interesting, and, at the end of their task, will feel grateful to 
the author for many very valuable suggestions as to the treatment of uterine diseases."— The 
Lancet. 

"Dr. Tilt's 'Hand -Book of Uterine Therapeutics' supplies a want which has often been 
felt. ... It may, therefore, be read not only with pleasure and instruction, but will also be 
found very useful as a book of reference."— The Medical Mirror. 

" Second to none on the therapeutics of uterine disease."— Journal of Obstetrics. 

VAN BUREN. 
Lectures upon Diseases of the Rectum. 

Delivered at the Bellevue Hospital Medical College. 
Session of 1869-'70. 

By W. H. VAN BUREN, M. D., 

Professor of the Principles of Surgery with Diseases of the Cenito- Urinary Orirans. etc.. in the 
Bellevue Hospital Medical College; one of the Consulting Surgeons of the New York Hos- 
pital, of the Bellevue Hospital ; .Member of the Now York Academy of Medicine, of the 
Pathological Society of New York, etc.. etc. 

1 vol., 12mo. 164 pp. Cloth, $1.50. 

"Tt seems hardly necessary to more than mention the name of the author of this admirable 
little volume in order to insure the character of his book. No one in thi» country has enjoyed 
greater advantages, and had a more extensive Held of observation in this specialty, than Dr. 
Van Bureu. and no one has paid the same amount of attention to the subject. . . . Mere is the 
experience of years summed up and given to the professional world in a plain and practical 
manner."— Psychological Journal. 



D. Appleton <b Co.'s Medical Publications. 27 

VAN BUKEN AND KEYES. 
A Practical Treatise on the Surgical 

Diseases of the Genito- Urinary Organs, including Sy}?hi- 
lis. Designed as a Manual for Students and Practition- 
ers. With Engravings and Cases. 

By W. H. YAN BUREN, A. M , M. D., 

Professor of Principles of Surgery, with Diseases of the Genito-Urinary System and Clinical 

Surgery, in Bellevue Hospital Medical College; Consulting Surgeon to the New York 

Hospital, the Charity Hospital, etc. ; and 

E. L. KEYES, A. M., M. D., 

Professor of Dermatology in Bellevue Hospital Medical College; Surgeon to the Charity Hospi- 
tal, Venereal Division ; Consulting Dermatologist to the Bureau of Out-Door Kelief, 
Bellevue Hospital, etc 

1 vol., 8vo. Cloth, $5.00; Sheep, $6.00. 

This work is really a compendium of, and a book of reference to, all modem 
works treating in any way of the surgical diseases of the genito-urinary organs. 
At the same time, no other single book contains so large an array of original 
facts concerning the class of diseases with which it deals. These facts are 
largely drawn from the extensive and varied experience of the authors. 

Many important branches of genito-urinary diseases, as the cutaneous mala- 
dies of the penis and scrotum, receive a thorough and exhaustive treatment that 
the professional reader will search for elsewhere in vain. 

Both to the specialist and the general practitioner the work commends itself 
as one of inestimable value. 

The work is a marvel of conciseness, and very rarely is so much condensa- 
tion accomplished without loss of any valuable points of detail. A glance at 
the table of contents will give an idea of the scope of the volume, but only a 
careful perusal of the work will convince the reader that full justice has been 
done to all the various branches of this highly-interesting class of diseases. 

The work is elegantly and profusely illustrated, and enriched by fifty-five 
original cases, setting forth obscure and difficult points in diagnosis and treatment. 

" The first part is devoted to the Surgical Diseases of the Genito-Urinary 
Organs; and part second treats of Chancroid and Syphilis. The authors 'ap- 
pear to have succeeded admirably in giving to the world an exhaustive and 
reliable treatise on this important class of diseases.' " — Northwestern Medical and 
Surgical Journal. 

" It is a most complete digest of what has long been known, and of what has 
been more recently discovered in the field of syphilitic and genito-urinary dis- 
orders. It is perhaps not an exaggeration to say that no single work upon the 
same subject has yet appeared, in this or any foreign language, which is superior 
to it." — Chicago Medical Examiner. 

11 The commanding reputation of Dr. Yan Buren in this specialty and of the 
great school and hospital from which he has drawn his clinical materials, together 
with the general interest which attaches to the subject-matter itself, will, we 
trust, lead very many of those for whom it is our office to cater, to possess them- 
selves at once of the volume and form their own opinions of its merit." — Atlanta 
Medical and Surgical Journal. 



28 D. Appleton & CoSs Medical Publications. 

VOG-EL. 
A Practical Treatise on the Diseases 

of Children. Second American from the Fourth 
German Edition. Illustrated by Six Lithographic 
Plates. 

By ALFRED YOGEL, M. D., 

Professor of Clinical Medicine in the University of Dorpat, Hauls. 
TEANSLATED AND EDITED BY 

H. RAPHAEL, M. D., 

Late House Surgeon to Bellevue Hospital ; Physician to the Eastern Dispensary for the Dlsoasee 
of Children, etc., etc. 

1 vol., 8vo. 611 pp. Cloth, $4.50. 

The work is well up to the present state of pathological knowledge ; 
complete without unnecessary prolixity; its symptomatology accurate, 
evidently the result of careful observation of a competent and experi- 
enced clinical practitioner. The diagnosis and differential relations of 
diseases to each other are accurately described, and the therapeutics 
judicious and discriminating. All polypharmacy is discarded, and only 
the remedies which appeared useful to the author commended. 

It contains much that must gain for it the merited praise of all im- 
partial judges, and prove it to be an invaluable text-book for the stu- 
dent and practitioner, and a safe and useful guide in the difficult but all- 
important department of Psediatrica. 

" Rapidly passing to a fourth edition in Germany, and translated into three 
Other languages, America now has the credit of presenting the first English ver- 
sion of a book which must take a prominent, if not the leading, position among 
works devoted to this class of disease."—^. Y. Medical Journal. 

" The profession of this country are under many obligations to Dr. Raphael 
for bringing, as he has dona, this truly valuable work to their notice." — Medical 
Record. 

"The translator has been more than ordinarily successful, and his labors 
have resulted in what, in every sense, is a valuable contribution to medica* 
science." — Psychological Journal. 

"We do not know of a compact text-book on the diseases of children more 
complete, more comprehensive, more replete with practical remarks and scientific 
facts, more in keeping with the development of modern medicine, and more 
worthy of the attention of the profession, than that which has been the subject 
of our remarks." — Journal of Obstetrics. 






D. Appleton & CoSs Medical Publications. 29 

WALTON. 
The Mineral Springs of the United 

States and Canada, with Analyses and Notes on the 
Prominent /Spas of Europe, and a List of Sea-side 
Resorts. An enlarged and revised edition. 

By GEORGE E. WALTON", M. D., 

Lecturer on Materia Medica in the Miami Medical College, Cincinnati. 

Second Edition, revised and enlarged. 1 vol., 12mo. 390 pp., with Maps. $2.00. 

The author has given the analyses of all the springs in this country and 
those of the principal European spas, reduced to a uniform standard of 
one wine-pint, so that they may readily be compared. He has arranged 
the springs of America and Europe in seven distinct classes, and de- 
scribed the diseases to which mineral waters are adapted, with refer- 
ences to the class of waters applicable to the treatment, and the pecul- 
iar characteristics of each spring as near as known are given — also, the 
location, mode of access, and post-office address of every spring are men- 
tioned, In addition, he has described the various kinds of baths and 
the appropriate use of them in the treatment of disease. 

EXTRACTS FROM OPINIONS OF THE PRESS. 

"... Precise and comprehensive, presenting not only reliable analyses of 
the waters, but their therapeutic value, so that physicians can hereafter advise 
their use as intelligently and beneficially as they can other valuable alterative 
agents." — Sanitarian. 

"... Will tend to enlighten both the profession and the people on this 
question." — N. Y. Medical Journal. 

"... Contains in brief space a vast amount of important and interesting 
matter, well arranged and well presented. Nearly every physician needs just 
6uch a volume " — Richmond and Louisville Medical Journal. 

"... Fills this necessity in a scientific and pleasing manner, and can be read 
with advantage by the physician as well as layman." — American Jour, of Obstetrics. 

TJNivEBsrrY of Vibginia, June 9, 18T8. 

Gentlemen : I have received by mail a copy of Dr. Walton's work on the 

Mineral Springs of the United States and Canada. Be pleased to accept my 

thanks for a work which I have been eagerly looking for ever since I had the 

pleasure of meeting the author in the summer of 1871. He satisfied me that 

he was well qualified to write a reliable work on this subject, and I doubt not 

he has met ray expectations. Such a work was greatly needed, and, if offered 

for sale at the principal mineral springs of the country, will, I believe, com- 

mand a ready sale. Very respectfully yours, 

J. L. Cabell, M. D. 



30 D. Appleton & Co?s Medical Publications, 

WELLS. 
Diseases of the Ovaries ; Their Diagnosis 

and Treatment. 

By T. SPENCER WELLS, 

Fellow and Member of Council of the Royal College of Surgeons of England ; Honorary Fellow 
of the King and Queen's College of Physicians in Ireland: Surgeon in Ordinary to the 
Queen's Household ; Surgeon to the Samaritan Hospital for Women; Member of the Im- 
perial Society of Surgery of Paris, of the Medical Society of Paris, and of the Medical Soci- 
ety of Sweden ; Honorary Member of the Royal Society of Medical and Natural Science 
of Brussels, and of the Medical Societies of Pesth and ilelsingfors ; Honorary Fellow of 
the Obstetrical Societies of Berlin and Leipzig. 

1 vol., 8vo. 478 pp. Illustrated. Cloth, Price, $4.50. 

In 1865 the author issued a volume containing reports of one hundred and! 
fourteen eases of Ovariotomy, which was little more ihan a simple record of 
facts. The book was soon out of print, and, though repeatedly asked for a 
new edition, the author was unable to do more than prepare papers for the 
Royal Medical and Chirurgical Society, as series after series of a hundred cases 
accumulated. On the completion of five hundred cases he embodied the results 
in the present volume, an entirely new work, for the student and practitioner, 
and trusts it may prove acceptable to them and useful to suffering women. 

"Arrangements have been made for the publication of this volume in Lon- 
don on the day of its publication in New York." French and German transla- 
tions are already in press. 

WAGNER 
A Hand-book of Chemical Tech- 

nology. 

By RUDOLPH WAGNER, Ph. D., 

Professor of Chemical Technology at the University of Wurtzburg. 

Translated and edited, from the eighth German edition, with extensive 

additions, 

By WILLIAM CROOKES, F. R. S. 

With 338 Illustrations. 1 vol,, 8vo. 761 pages. Cloth, $5.00. 

Under the head of Metallurgic Chemistry, the latest methods of preparing Iron, Cobalt, 
Nickel Copper, Copper Salts. Lead and Tin." and their Salts. Bismuth. Zinc, Zinc Salts, Cad- 
mium. Antimony. Arsenic, Mercury. Platinum. Silver. Gold, M animates. Aluminum, and 
Magnesium, are described. The various applications of the Voltaic Current to Electro-Metal- 
lurgy follow under this division. The preparation of Potash and Soda Salts, the manufacture 
of Sulphuric Acid, and the recovery of Sulphur from Soda Waste, of course occupy prominent 
places in the consideration of chemical manufactures. It is difficult to over-estimate the mer- 
cantile value of Mond's process, as well as the many new and important applications of Bisul- 
phide of Carbon. The manufacture of Soap will be found to include much detail. The Tech- 
nology of Class, Stone-ware, Limes, and Mortars, will present much of interest to the Builder 
and Engineer. The Technology of Vegetable Fibres has been considered to include the prep- 
aration of Flax. Hemp. Cotton. 'as well as Paper-making: while the applications of Vegetable 
Products will be found to include Sugar-boiling. Wine and Beer Brewing, the Distillation of 
Spirits, the Baking of Bread, the Preparation of Vinegar, the Preservation of Wood. etc. 

Dr. Wagner gives much information in reference to the production of Potash from Sugar 
residues. The use of Barvta Salts is also fullv described, as well as the preparation of Sugar 
from Beet-roots. Tanning, the Preservation of Meat. Milk. etc.. the Preparation of Phospho- 
rus and Animal Charcoal, are considered as belonging to the Technology of Animal Products. 
The Preparation of Materials for Dveing has necessarily required much space ; while the final 
sections of the book have been devoted to the Technology of Heating and Illumination 



•*■ 



NEW MEDICAL WORKS IN PRESS. 



Bartholow's Treatise on Therapeutics. 

Clinical Lectures and Essays. By Sir James Paget, 

Bart., F. R. S., D. C. L., Oxon., LL. D., Cantab. ; Sergeant-Surgeon Extraor- 
dinary to her Majesty the Queen, Surgeon to H. R. H. the Prince of Wales, 
Consulting Surgeon to St. Bartholomew's Hospital. Edited by Howard- 
Marsh, Assistant Surgeon to St. Bartholomew's Hospital, and to the Hos- 
pital for Sick Children. 1 vol., 8vo. Cloth. Price, $4.50. 

Acne ; its Pathology, Etiology, Prognosis, and Treatment. 
By L. Duncan Bulkley, A. M., M. D., New York Hospital. 
A monograph of about seventy pages, illustrated, founded on an analysis of two hundred cases 
of various forms of acne. 

Orthopedic Surgery. With the Operations incident to De- 
formities. With numerous Illustrations. By Lewis A. Sayre, M. D. 

The Common Forms of Paralysis from Brain-Disease. 

By Dr. H. Charlton Bastian. 

r>_ -A-zpipzcetount Sz co., 

549 & 551 Broadway, New York. 




/%K. 



THE NEW YORK MEDICAL JOURNAL. 

JAMES B. HUNTER, M. D., Editor. 
Published Monthly. Volumes begin in January and July. 



" Among the numerous records of Medicine and the collateral sciences published in America, 
the above Journal occupies a high position, and deservedly so." — The. Lancet (London). 

" One <. f the best medical journals, by-the-by, published on the American Continent."-- Lon- 
don Medical limes and Gazette. 

"A very high-class journal." — London Medical Mirror. 

" The editor and the contributors rank among our most distinguished medical men, and each 
number contains matter that does honor to American medical literature." — Boston Journal of 
Chemistry. 

"Full of valuable original papers, abounding in scientific ability." — Chicago Medical Times 

"We kno'v no other periodical that we would rather present as a specimen of American skib 
and intelligence than the New York Medical Journal."— Franklin Repository. 

" The New Yoke Medical Journal, edited by Dr. James B. Hunter, is one of the sterling 
periodicals of this country. The present editor has greatly improved the work, and evinces a 
marked aptitude for the responsible duties so well discharged. The contents of this journal are 
always interesting and instructive ; its original matter is often classic in value, and the selected 
articles are excellent exponents of the progress and truth of medical science."— Richmond and 
Louisville Medical Journal. 

Terms, $4 per Annum. Specimen Copies, 25 Cents. 



THE POPULAR SCIENCE MONTHLY. 

Conducted by Prof. E. L. YOUMAJYS. 

Each Number contains 128 pages, with numerous Descriptive and 
Attractive Illustrations. 

Published Monthly. Volumes begin in May and November. 

Terms, $5 per Annum, or Fifty Cents per Number. 



The Popular Science Monthly was started to promote the diffusion of valuable scientific 
knowledge, in a readable and attractive form, among all classes of the community, and has thus 
far met a" want supplied by no other periodical in the United States. 

The great feature of the magazine is, that its contents are not what science was ten or more 
years since, but what it is to-day, fresh from the study, the laboratory, and the experiment: 
clothed in the language of the authors, inventors, and scientists themselves, which comprise the 
leading minds of England, France. Germany, and the United States. Among popular articles, 
covering the whole range of Natural Science, we have the latest thoughts and words of Her- 
bert Spencer, and Professors Huxley, Tyndall, and R. A. Proctor. Since the start, it has proved 
a gratifying success to every friend of scientific progress and universal education ; and those who 
believed that science could not be made any thing but dry study, are disappointed. 

The press all over the land is warmly commending it. We subjoin a few encomiums from 
those recently given: 

" A journal which promises to be of eminent value to the cause of popular education In this 
countrv'."— .N ew York Tribune. 

" It is, beyond comparison, the best attempt at journalism of the kind ever made in this coun- 
try."—//^ Journal. ■ . 

"The initial number is admirably constituted. —Evening Mail. 

" In our opinion, the right idea has been happily hit in the plan of this new monthly.' —Buffalo 
Courier. , „ _, . , _ .. 

" Just the publication needed at the present &sy.—M07itreal Gazette. 

Payment, in all cases, must be made in advance. 

Remittances should be made by postal money-order or check to the Publishers, 

JD. JlJPPLETON & CO., 

549 & 551 Broadway, Netv York. 



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